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Home My WebLink About032-2138-50-000 Wisconsin DepMtment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix � Safef� and 2uilding Division. INSPECTION REPORT Sanitary Permit No: 430454 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: Weaver, ,John I Somerset Township 032 - 2138 -50 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: lop / v a , ( I J D ov S'- I ov) wcJ �L L7u. � air) 14.30.19.1222 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic Benchmark OO 8a? 33 00 -�� Dosing Alt. BM Aeration Bldg. Sewer ¢sS Holding 1 St/Ht Inlet J c St/Ht Outlet TANK SETBACK INFORMATION 1 '7 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 7 / t L � Dt Bottom r / Dosing _ Header /Man. 9L L7 Aeration '` Dist. Pipe / Holding ~• .. Bot. System Final Grade ' PUMP /SIPHON INFORMATION Manufacturer -" ` Demand St Cover } GPM 5< /00 Model Num r t 71. 3 7 TDH Lift tion Loss System Head T H Ft Forcemain Length Dia. SOIL ABSORPTION SYSTEM ,,- 1 1-1 ` BED/TRENCH Width Length- `.�.. No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS I ,,# l _ _ SETBACK SYSTEM TO P/L IBLDG IWELL ► j if EAKE/STREAM LEACHING Manufacturer: 1) , INFORMATION CHAMBER OR Type Of System: UNIT Model Number: c / O ki fI DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size Ix Hole Spacing Vent to Air Intake Length_ Dia Length Dia _____ Spacing -� SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over Ixx Depth of xx Seeded /Sodded xx Mulched BedlTren Bed/Trench Edges Top,�,gj] ..._.__. COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: /f ! Inspeotion^#£? " - = - "= �" Location: 1581 72nd St Somerset, WI 54025 (NE 1/4 NW 114 14 T30N RI 9W) Rockamora Estates Lot 11 Parcel No: 14.30.19.1222 1.) Alt BM Description = V � V PA C� 2.) Bldg sewer length - amount of cover = e!' Plan Use other for add t' al in Yes U No I I J information. SBD -6710 (R.3/97) Date nsepctor's Signature Cart. No. I � Safety and Buildings Division County Npisc 201 W. Washington Ave., P.O. Box 7082 ; C Onsin Madison, WI 53707-7082 Sanitary Permit Number (to be filled in by De artment of Commerce (608) 261 -6546 O 9 Sanitary Permit Application State Plan I.D. Number /1 In accord with Comm 83.2 1, Wis. Adm. Code, personal information you provide / J may be used for secondary purposes Privacy Law, s 15.04(I)(m) Project Address (if differ than mailing address) I. Application Information — Please Print All Information / 5—if/ ? A r Property Owner's Name Parcel # OC t # Block # k Property Owner's Mailing Address /� Property Location s / �. . City, State Z Code •= !J 'Phone u & Z %, 4t&l, Section trcl e ) fI Q -, n vl ^Ji, T'0 N, R�'rof4�V II. Type of Building (check all that apply) _ (/ j um 0 I or 2 Family Dwelling - Number of Bedrooms 3 Subdivision Name CSM N� ❑ Public/Commercial - Describe Use L ❑ State Owned - Describe Use L✓ j'' 7 ❑Ci _ ❑Village ffownship of v III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ys ❑Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System B, List Previous Permit Number and Date Issued ❑ Permit Renewal 10 Permit Revision ❑ Change of etmit� sfer to New Before Expiration Plumber Owner w ' ,' # U 9 p � - IS-23 IV. T W Type of POTS System: Check all that apply) , U�CJ� 1 0 Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter VLching C ber ❑ Drip Lin ❑ -less Pi ❑ Other (exp * Z V. Dis ersaUTreatment Area Inf rmation: (S Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Pro sed s Syste levation'— g VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons g Gallons of Units Concrete Conswcted Glass New Exislin Tanks Tanks Septic or Holding Tank D 000 , Aerobic Treatment Unit Dosing Clamber VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) P b 's Signature PR umber Business Phone Number / �^-'/ — � �, o 9.1 = Z 7!!KZ .s-.S o J 1 Plumber's Address (Street, City, State, Zip Code) Lc' —v - s o �� VIII oun /De artment se Onl Approved ❑ Disapproved Sanitary Permit Fee includes Groundwater Date sued is ng Agcnt S natu a (No ps) Surcharge Fee) V D ❑ Owner Given Reason for Denial f , ZO o3 IX. Conditions of Approval/Reasons for Disapproval 2 bJ03 � � J A7 SYSTEM OWNER: 1 Septic tank, effluent filter and t dispersal cell must all be serviced / maintained as per management Plan Provided by lumb r Z. All setback requirements%M%? "e+MA*Tmimt4County only) for the system o not less than 81/2 a It Inches In size as per applicable code /ordinances. SBD -6398 (R. 08/02) I , � I � ✓DES • I I I I I I I I I C f -- -- - Eye I - I : I I I T14 , I s I � b i I I T i I I i I , I i C3 , I - _ rEn I I 9� I E L 10 v e f I - i I 1 I I - - 'WO, ' I I I �II I I I I i VeWT 3S - 7 <s 31 _ �STE/ )Pnon ea t y C-I Ne l j _ 3 " K 8o, 73 � FJ T.2Frircr� g. 81 � { � t'jousr' f Co TER' C�t ��t000s�n 9Y' gAtT ark lo a " Puc_�q EL - _M-7 —z _ EC ORAa)iNG TIZ S�? 5-- _ __ _ _ — __ i ___ _ _ _ __ __ _ _ ____ __ _ a _ _ — —_ ____ _ __ _._ __ __ __._ __ _ __ __ __ __ ........._... . __ __ _ _ __ __. __ ___ __ — __ __ . _.....:..._....._. 1172 Wisconsin Department of , S IL EVALUATION REPORT Page 1 of 3 r 2003 Division of Safety and Buildii igs in accordance w h Comm 85, W is. Adm. Code Tom Schmitt Attach complete site non ' i t;( "% County plet �' � l l l inc in size. Plan must St. Croix include, but not limit (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest mad. Parcel I. D. 032 -21A-50-000 Please print all information. R 'awed By Date Personal information ym provide may be used for secondary purposes (Privacy law, s. 15.04 (1) (m)). rQ d Pr Owner Property Property Location Weaver, John And Mary Govt. Lot NE 1/4 NW 19 S 14 T 30 N R 19 W Property Owners Mailing Address Lot # Block # Subd. Name or CSM# 218 W. Charlotte Apt. 109 11 Rockamora Estates City State Zip Code Phone Number J City J Village a Town Nearest Road River Falls WI 1 54022 1 715 - 425 - 0082 1 Somerset I 72Nd St. New Construction Use: 10 1 Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement _j Public or commercial - Describe: Parent material Glacial Till Flood plain elevation, if applicable na General comments and recommendations: Area is suitable for a conventional system wih a 0.4 gpd/scift rating. Possible system elevation is 93.5% Boring # I Boring 0 Pit Ground Surface elev. 97.06 ft. Depth to limiting factor 95+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF *Eff#1 *Eff#2 1 0 -10 10yr3/3 none I 2msbk mfr cs 2m2f .5 .8 2 10 -24 7.5yr4/6 none grsl 2msbk___ mfr gw 2f .5 .9 3 24 -95 7.5yr4/4 none grsl 1 msbk mfr — - -- .4 6 -7 a Boring # J Boring V1 Pit Ground Surface elev. 97.06 ft. Depth to limiting factor 96+ in• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft *Eff#1 *Eff#2 1 0 -11 10yr3/3 none sil 2fsbk mfr cs 2m2f .5 .8 2 11 -24 10yr5/4 none I 2msbk mfr gw 2f .5 .8 3 24 -39 7.5yr4/6 none grsl 1 msbk) mfr gw -- -- .4 .6 4 39 -96 7.5yr4/4 none grsl 2msbk mfr -- -- 5 .9 * Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD .S 30 mg/L and TSS <_W mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt �.. �,�_� 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 1595 72nd St., New Richmond, WI 54017 820/03 715- 247 -2941 J Property owner Weaver, John And Mary Parcel ID # 032 - 2138 - 50-000 Page 2 of 3 3 ] F Boring # Boring 101 Pit Ground Surface elev. 92.31 ft. Depth to limiting factor 97+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD 'Eff#1 *Eff#2 1 0 -10 10yr3/3 none sil 2fsbk mfr cs 2f .5 .8 2 10 -22 10yr5/4 none sil 2msbk mfr gw 1f .5 .8 3 22 -32 10yr4 14 none I 2msbk mfr gw — .5 .8 4 32 -59 7.5yr4/6 none fsl 2msbk mfr cw — .5 .9 5 59 -97 7.5yr4/4 none grsl 2msbk mfr - - -- ----- .5 .9 F-1 Boring # Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 2 'Eff#1 *Eff#2 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 *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 ecjyal opportunity service provider and employer. if you need assistance to access services or need material in an alterna*4wmat, please contact the department at 608- 266 -3151 or TTY 608 - 264 -8777. Grn0rt,. A AA 61VI Z b - si ll ova l o l k o t �r/ / L4. [� •fi , 1� I i /08r I � r 72n j- f t �ok SI IJ. C h d ,- l& fly ,,D y 1 1WC�K -Ci hs o, /rP 4;e4,•.-a'►sWi I✓Z fvo l N, Nii- VV 7 1 Al t w e . - ,op? 9 K - 03.2 t3 8 — s`o —� / ;1 2405P 021 73939a KATHLEEN H. WALSH STATE BAR OF WISCONSIN FORM 2 -19W REGISTER OF DEEDS WARRANTY DEED ST. CROIX CO., NI Document Number RECEIVED FOR RECORD This Deed, made between Thomas Schmitt 09/10/2003 09:30AN WARRANTY DEED EXEMPT # Grantor, and John Weaver and Mary Weaver, husband and wife REC FEE: 11.80 TRANS FEE: 209.70 COPY FEE: CC FEE: PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Lot 11, Rockamora, Town of Somerset, St. Croix County, Wisconsin. ��,�•. Estreen & Ogland 304 Locust Str W 1 ' Hudson, W! 54076 1 001)Z 032- 2049 - 60-000 Parcel Identification Number (PIN) This is not homestead property. 00 (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this , day of July ' 2003 L. + • Thomas Schmitt AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. County ) authenticated this day of r� Personally came before me this day of July 1 2003 the above named 8 hy Thomas Schmitt TITLE: MEMBER STATE BAR OF WI t�0 S 9 (If not, E' Z me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) 1p ?y strumen and acknowl ged the same. THIS INSTRUMENT WAS DRA •. « „... � Attorney Kristina Ogland OF Notary P b c, State of Wisconsin Hudson, WI 54016 My Co sion is permanent. (If ot, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) -- , L •) • Names of persons signing in any capacity must be typed or printed below their signature. trdarmetion Professionals comvwr. Fond du Lac. WI STATE BAR OF WISCONSIN 800455 - 2021 WARRANTY DEED FORM No. 2 -1999 6 32 — 213 Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 - 5 ( . CeD f Madison, WI 53707 - 7162 Site Address De artment of Commerce * 150 72 Sanitary Permit Application Sanitary permit Number In accord with Corms 83.21, Wis. Adm. Code, personal information you provide El Check if Revision O9 n Z my be used for secondary purposes Privacy Law, sl5. 1 m I. Application Information - Please Print Ali Info RECEIVED State Plan I.D. Number Property Owner's Name Parcel Number MAY 1 4 2003 Property Owner's Mailing Address Property Location LLE, t ST. CRUIX COUNTY NING OFFICE IKE7 if AW 5f; S T N. R City, State Zip Cod one Numher Lot N r Block Number f Subdivision Name CSM Number Dl r�ns� �Ya1 3 -s 170 AAA19dA II. Type of Building (check all that apply) oo sw(ow�� he at .3 ❑City K I or 2 Family Dwelling - Number of Bedrooms nti S . ❑Village ❑ Public/Commercial - Describe Use &ownshig ❑ State Owned }� S / Nearest Road 3 7 N,6 Sr M. Type of Permit: (Check only one ox on We A (numbering scheme for ternal use). Complete line B if appli A. 1 % New 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ on to For Coggy use .. system I XTank Only stem I %E 1. B. ❑ Check if Sanitary Permit Previously Issued Pecmit Number sued r IV. Type of Permit: (Check all that apply)(num Winscheme for internal use) { j 44 re Non - Pressurized In- Ground 210 M ound 47 ❑ Sand Filter 50 ❑ Constructed Wedand su 22 ❑ Pressurized In -Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line`s 45 ❑ At -Grade 46 ❑ Actobic Tres 49 ❑ Recirculating 3Q ❑ V. tment Area Information: - 1 OD Design Flow (gpd) Dispersal Area Dispersal Aria So lication Percolation Rate System Elevation Final Grade Required Proposed. x / Days /Sq.FL) (Min.fInch) Elevation y 5 �. 97. VI. Tank Info Capacity in T Number MAO cturer Prefab Site Steel Fiber Plastic Gallons ons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank M i Dosing Chamber VII. Responsibility Statement- the undersigned, assume responsibility for installation of the PO own on the attached plans. Plumber's Name (Print) P1 's Signature M S Number Business Phone Number - 2l s=3 Y -&- 6 Plumber's Address (Street, , State, Alp Code) L - VIII. County/Di t Use Onl Approved ❑ pproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) ❑ Owner Given Initial Adverse Determination IX. Conditions of Appr for Disapproval VNA Attach complete Vians (to County only) for the system on pap not than 8 s 11 inebes m size V� � a SBD -6398 (R. 0510 � y„ p ut: I vr e- itvs/iK% //'P/l ox Iox - i 3s , 5 t A91 Rio /,0 ;3' - — IYiiv 7',' 3 t M ,1Al' 3 3 r tL.i 9G �2 97, 199 cl 99 2 li TH c 14 - - - L 3 tx 80, ?3 Bi`o D"l-Fys�2 at- !� 49 / J00 - 1 l ob! 0 05 �0 Gfj t-L DRrv� way _ s � <- y1? OP UC ! _L E 1-o7 /FCC IVA /7012A L' �d2 .' ��u1��✓ !h`oris��r� s 96 VA c« y 4,ve o 7R 58� _ 1/ 44C. & , c%-= tv 72 c� /fit t?SET- !-tilt' S Y ®.Z s �d/7E2xe --r � orb I � _ __ _ _ __ ____ ___ _ __ - __ _ _ _ __ _ __ -- _ _ -_ __ __ _.__ _ __ __ __ ____. L __ _ __ __ __ _ _ __ __ - __ __ ___ _ _ _ __ __ _ __ __ _ _ _ ___ _ __ _. ___ _ _ __ ___ __ __ __ _ __ _ - ___ _. __ __ _ - ____ __ _ __ _ __ __. ___ __ _ __ __ _ __ _ ___ _ __ __ __ __ -_ _ -_ __ rviswusitl %NalujiuvaufCoFrin - jerce 3 A IL AN 1 EV ALU ATION Pa of av v SI EV e 1 U g Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code • Tom Schmitt 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 reference @M), direction and St. Croix percent slope, scale or dimensions, north arrow, 1 o and mince to nearest road. Parcel I.D.# APPLICANT INFORMATION - P;1 "�t all 'nformatioit " P of 032 -2 49 -60 -0 & 032 - 2049 -70 -0 , sewed By e Personal information you provide may be used �n8ary (ppracy Law S. 15..04 (1) (m)). r 3 .('? "1'. 1 Property Owner ' Property Location Rivard, Harold And Belisle, Ro F Gavtl Lot na NE 1/4 NW 1/4 S 14 T 30 N,R 19 W Property Owner's Mailing Address ~ 4 Lot Block # Subd. Name or CSM# ST CRUX 812 150th Ave r, A l na Rockamora it City State Pbr:Gc City ❑ Village ❑Town Nearest Road New Richmond W1 54 5- 246 - 5291 - ' `� Somerset 160Th Ave ❑New Construction Use: � Residen ' _ j r drooms 3 _]Addition to existing building ❑ Replacement ❑ Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate .4 bed, gpd /ft .5 trench, gpd/W Absorption area required 1125 bed, ft 900 trench, ft Maximum design loading rate .4 bed, gpd /ft .5 t rench, gpd/ft Recommended infiltration surface elevation(s) Areal 100.20' ft (as referred to site plan benchmad Additional design / site Consideration Area 1199.2'& 96.2' Parent material Pitted Glacial Drift 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 for system ® S❑ U ❑ S❑ U ❑ S❑ U 0 S❑ U ❑ S M U ❑ S N U SOIL DESCRIPTION REPORT N �, s - I,Zem7 l Horizon Depth Dominant Color Mottles Texture Structure Consisten Boundary Roots GPD Q. Boring# in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed trench *_ t 1 0 -8 10yr3/3 none sit 2msbk mfr cs 2f .5 .6 S� 2 8 -27 7.5yr4/4 none sl 2msbk mfr gw - - - - -- .5 .6 S- Ground 3 27 -68 7.5yr4/6 none A 2msbk mfr gw - - - - -- .5 .6 s- elev 103.75 ft 4 68 -92 7.5yr4/6 none sl 2msbk mfr - - -- - - - - -- .5 .6 S� Depth to limiting factor >92" Remarks: 1 L 0,0�3 0 -9 10yr3/3 none sit 2fsbk mfr Cs if .5 .6 2; � 2 9 -32 7.5yr4/3 none scl 2msbk mfr gw if .4 .5 f Ground 3 32 -90 7.5yr4/4 none grsl 2msbk mvfr - - -- - - - - -- .5 .6 ` S elev 103.82 ft Depth to limiting factor >90 Remarks: CST Name (Please Print) Signature: Telephone No. Thomas J. Schmitt / � :fJ�% 715 -549 -6651 Address Tom Schmitt Date CST Number Ref # 586 Valley View Trail, Somerset, Wl 54025 5/3/00 227429 1005 PROPERTY41WNER: Rivard Harold And Belisle, Roland SOIL DESCRIPTION REPORT tioo5 Page 2 of 3 PARCEL I.D.# Part of 032 - 2049 -60 -0 & 032 - 2049 -70-0 Tom Schmitt ` Depth Dominant Color Mottles Structure GPDlft Horizon in Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench 3 1 0 -6 10yr3/3 none sil 2fsbk mfr cs if 5 6 S� G. 2 6 -15 10yr4 /4 none A 2msbk mfr gw - - - - -- .5 .6 Ground elev 3 1546 7.5yr4/4 none s1 lmsbk mfr gw - - - - -- .4 .5 ' f 103.64 ft 4 46 -92 7.5yr4/4 none grsl 2msbk mfr - - -- -- - - -- .5 .6 Depth to limiting factor >92" 2 0 S'3•Z� •2� Remarks: 1 0 -10 10yr3 /3 none 1 2fsbk mfr cs if .5 .6 S ,z 2 10 -30 10yr4/4 none s1 2msbk mfr gw .5 .6 S Ground elev 3 30 -90 7.5yr4/4 none grsl 2msbk mfr - - -- - - - - -- .5 .6 99.19 ft Depth to limiting factor >90" Remarks: Fa a 41 1 0 -8 10yr3 /3 none 1 2fsbk mfr cs if 5 6 S 5 .A 2 8 -32 10yr4/4 none sil 2msbk mfr gw - - - - -- .5 .6 S Ground elev 3 32 -90 7.5yr4/4 none grsl 2msbk mfr - - -- - - - - -- .5 .6 100.14 ft Depth to limiting factor >90" Remarks: AI h �y Ground eiev Depth to limiting factor Remarks: I I at '- I : I I I I i i i I j I - - i I 37 I : � I a I 93 , Q IiOG- I I � � I : , I - - ;- - -- - - - _ - I : I 2 I I - _ I : I I i i F i I � 1 I 1 � I - -- y - - - - . I go All _� I _ _ __ _ _ i � � �, � i ._ - ' 1 L . i '. � �_- — __ _ _ � ___ l __ ._ ___._ _ i - �— •� �, r � �, —_ i a I � i � ' �_ � � t �_ _ _.. _ _ I I_ I _ _ i_ � .... � __ _ ! __ i i i i � � � 1 —. ._ j_ i I i I i I �. _ ; i — __ , — _, _ __ _ i — - — _,. .h �� - � � ' I i a �, � � � ; ,. i �. � � � i ___ _ _ _ -. _ ti ;_ _ _ . _ _ _ . �_ __._ _ �;__ __. -�- __ _. _ {___. __.. t - -- , i t � � t ._ l_ �. _ . � �i �� - f '. _ __ _ _ _- , � �, � i I ;. i � � � ,. � 1 __.. ' , �.. 1 i , _ �, I i r i � I � i ,, i. � � � .. � :�. � �. a ... i � j. �. F i I � ._ i � - - .,,. ' I � i i I i � i � �� : � � � � I i � � _ � � i i — i I- � � � �-- �. � i i + � � � i i �- � E- I � h �. .�. i � I � � i � i � I � � � ; _ ; _- � r -- - _ _ - �- - -i - - - - -- I :. � � -r - � � ; _ . � - � - -� r ;_ i j, � � ! � i i i i �� r - ' � � � ' � ' � ' 1 ;— � __�� -- � _ — I � I i � 1 I j � �. t �; � � i I I ,_ � , ;. �_...... i ._ __.. .. _. _ ... i r - - -- -` --- ,, 7 i t�� j � � � � F l f _ -_ ,_ ' � i i i F � , , � � ' ... i � l �_ - i � � —__- � � � � _ _ _. _.. i ___( � -- � -- - r -- — � �. i _ � � � j i _! � i �__. _ � _ __ � a ._ i �, 1 t ', I I � i ', i I i i_. I i. _ i :. i i �' A I - �',, �. �. � ', � � � � � � ! ' i � � i i + .. _� — r — � � — I— �— f I � - � � _ � ,.. I i � i �" I i _..; � � I � ' - I — - - � ST CROIX COUNTY RECEIVED SEPTIC TANK MAINTENANCE AGREEME AND OCT 2 8 2003 OWNERSHIP CERTIFICATION FORM �6J --lrJ n L IZ— ST. CROIX000NTY Owner/Buyer ft ZONING OFFICE Mailing Address Z A I?- Lz TT /�''P� D - �l U oZZ Property Address (Verification required from Planning Department for now construction) CitytState Parcel Identi fication Number _ t� 3 Z - c2 1E9AL DESCRIPTION r Proper Location �j C- 'j, '%, Sec. T3N -?�__dW; Town of v6Yh -s ue Subdivision RO C K A }' a P , Lot # Certified Survey Map # , Volume �I . .Page # Warranty Deed # `73 j . � � �J , Volume 2 ` 4 S - , Page # 0 Z Spec house ❑ yes no Lot lines identifiable 19 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 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 wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank's 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 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. / /O IGNI APPLICANT DA 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 owners) of the property described abov by virtue of a warranty deed recorded in Register of Deeds Office. SI F 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 stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed { POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page —1 of FILE INFORMATION SYSTEM SPECIFICATIONS Owner 1J Septic Tank Capacity ❑ a l NA Permit # 2 Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer z ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model _ ❑ NA Number of Public Facility Units J1 NA Pump Tank Capacity a l eF NA Estimated flow (average) Q al /da Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) allda Pump Manufacturer 12 NA Soil Application Rate gal/day/ft' Pump Model 01 NA Standard Influent /Effluent Quality Monthly average` Pretreatment Unit 19 NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L a In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L 0 NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y, in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA `Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 0 ear(s) s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every 0 yeast 1(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ❑ month(s) ❑ NA i. ❑ year(s) ❑ month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ year(s) ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: ❑ year(s) ❑ month(s) Other: At least once every: ❑ year(s) Q NA Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) 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 cell(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. Page 2- of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) 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 normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cells) 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 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 POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting 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 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 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 soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, 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. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS 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 POWTS. ❑ 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. < <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 COMMENTS POWTS INSTALLER POWTS MAINTAINER Name _ Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name — r^ Name —. Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(dl &(f) and 83.54(1), (21 & (3), Wisconsin Administrative Code. ST CROIX COUNTY • SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 7_1.0 /% S 5r W Y1 7 - T Mailing Address = Property Address (Verification required from Planning Department for new cons truc ' a) 03Z - City/State r SnPr gases 7 Parcel Identification Number - - o o 3 2 - - 7 - 1 Sv - G LEGAL DESCRIPTION Property Location AIC-'_ '/4, ,A(W %4, Sec. // Town of S=dfA C-' Subdivision Lc a 4 a-a R A . Lot # Certified Survey Map # ? Volume �` . Page # �— Warranty Deed # :3 9 r ' y , Volume 15 s� , Page # , .4/7 Spec house Eryes ❑ no Lot lines identifiable dyes 0 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 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 mastcrplumber, journeyman plumber, restrictedplumber or a licensed pumper verifying that (1) the on-site 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, 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. SIGNA 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 owners) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNA OF APPLICANT DATE * * * ** Any information that is mis- represented may result in th sanitary permit being revoked by the Zoning Department. "" " 0 * 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 III VOL 1595FAa 117 STATE BAR OF WISCONSIN FORM 1 t - IM 639644 LAND CONTRACT KATHLEEN H. NALSH IrAvidusl and Coma ST. CROI at 0€ )SEEDS (TO RE USED FOR ALL TRANSACTIONS WHERE OVER ST. prJFX Ct}. r W1 S23AM IS FINANCED AND IN OTHER NOWCONSUMER RMY9 FIR Meanest Naaber ACT TRANSACTIONSI 03 -M-Mi 2:46 1 CONTRACT, by and between Harold K. Rivard and Roland J. Belisle L ETC �ifM CW M FEE- CONY FEE: TRA O R FEE: 119.0 RECWJTW 12 ( "Vendor", whether one or more) and Thomas Schmitt FEE- .00 Prtl�Ss __ Recording Ales ("Purchaser', whether one or more). Vendor sells and agrees to convey to Nano watt Return Addrw purchaser, upon the prompt and full performance of this contract by Purchaser, the following property, together with the rents, profits, fixtures and other KRISTINA OGLAND appurtenant interests (all tailed the "Property'), in St. Croix ESTREEN & OGLANQ County, Stale of Wisconsin: 304 focus Hudson, m 54016 032 - 2049.60.000 (Prod Mcatiftcation Number) i_+13t l , Ro *4mors, Town of Somerset, St. Croix County, Wisconsin. This is not bomestead property. ()4} (is not) Purchaser agrees to purchase the Property and to pay 10 Vender a t p lan Vendor dkwb the sum of S 39,750.00 in the following manner: a) at the execution o f rac this Contt; an (b) the balance of T 38,000.00 � , together with interest from hereof on the balance outstanding from time to time at the rate of 11.5 %& percent per annum until paid in full, as failows: Commencing on the 270 day of Ntarcb, 2001, sad on the 2116 day of each and every mend; Own #v ter. equal monthly installments orprim►cipst and Interest is the smoust ofS374.20 Provided, however, the entire outstanding balance shall be paid in full on or before the 271b day of February 2004 (tire maturity date). Following any default in payment, interest shall accrue at the rate of %per annual on the antra amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). Purchaser, unless excused by Vendor, agrees to ay monthly to Vendor amounts sufficiew to pay reasonably antici- pated annual taxes, special assessments, fire and required insurance premiums when due. To the extent received by Vendor, Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear int«mc unless otherwise required by law. Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any amount may be p r e p a i d without premium or fee upon principal at anyy ti after day of etosbg. + - � eade in the event of any prepayment. this contract shall not be treated as in default with respect to payment so 1 as the unpaid balance of principal, and interest (and in such case scenting interest from month to month shalt be treated as unpaid principal) is less than the armor that said indebtedness would have been had the monthly payments been made as first specified above. provided that monthly payments shall be continued in the event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded hcrefrom. Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except: Purchaser agrees to pay the cost of future title evidence. If tide evidence Is in the form of an abstract. it shall be retained by Vendor until the full purchase price is paid. 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