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CROIX COUNTY COMMERCIAL USE 10 A SUPPLEMENTAL Planning & Z oning ' INFORMATION SHEET ��� Yom• ... - R • The special exception permit application must be completed and signed by the property owner, as well as anyone acting as agent for or on behalf of the property owner. • To avoid duplication, the application may reference information already on file with the Zoning Administrator. • In addition to the information requested on the special exception permit application, you must also provide the following information: ❑ Description of Business ❑ Hours of Operation ❑ Number of Employees (PT /FT /Seasonal /Temp) ❑ Site Plan (w /dimensions, setbacks, and square footage): • Structures (existing and proposed) • Sanitary System • Parking Lot (with total # of paved stalls) • Entrances /Driveway Accesses (all must be paved) • Outside Storage Areas • Lighting • Signage ❑ Landscaping Plan ❑ Storm Water Management Plan ❑ Erosion Control Plan (for new construction and /or filling and grading activities) ❑ Daily Traffic Estimates ❑ Elevation Drawings for proposed buildings and structures) g ( P p g ti ❑ Town Approval (Contact your town to ensure that your application is on the Planning Commission and Town Board meeting agendas in time for the town to submit a recommendation to the County Board of Adjustment.) ❑ Other Information: QUESTIONS? Please contact: St. Croix County Planning and Zoning Department, 715 - 386 -4680 Rev. December 15, 2006 Wisconsin Department of commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 463166 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: Wachter, Dave Somerset Township 032 - 2062 -50 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: ''��jj �C �1 L�(� ,,,•� Pe 18.30.4.745H TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 3 ;4- Benchmark ' S �; q. v in Alt. BM Aeration Bldg. Sewer Z 1H 1 9 Holding St/Ht Inlet U / TANK SETBACK INFORMATION St/Ht Outlet 7' TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \` Septic 7S6 AZ —71 i '7 /j' _ Dt Bottom \� \ Dosing Header /Man. Aeration Dist. Pipe to 117 0 Holding Bot. System Final Grade PUMP /SIPHON INFORMATION (v • Cod /OZ • 3S Manufacturer Demand St Cover GP � Model Number j 1 12 .O y�o `1g TDH Lift Friction Loss System H Ft Forcemain Lengt ia. Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width J Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liqui Depth DIMENSIONS `\ \ \ -- i SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer. ` r INFORMATION CHAMBER OR C-O Type Of System:. -7 �O UNIT Model Number. C C;A%j �; a Q u DISTRIBUTION SYSTEM o fk / - 3Le % aL—� Header/Manifold „ Distribution ` x Hole Size x Hole Spacing Vent to Air Intake Length Pipe(s) \ � \ Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mul Bed/Trench enter 3' ch C Bed/Trench Edges Topsoil \ 7 Yes No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1576 County Road y Somers WI 54025 (NW 1/4 NW 1/4 18 T30N R19W) NA Lot 1 Parcel No: 18.30.18.745H 1.) Alt BM Description 2.) Bldg sewer length - amount of cover Plan revision Required? I Yes No 1„� S, b5 u 3 1 Use other side for additional information. Date Inse ors S• ature Cart. No. SBD -6710 (R.3/97) , Safety and Buildings Division County„ / 1 W201 W. Washington Ave., P.O. Box 7162 C0nsn Madison, WI 5370Z— 7162 Sanitary Permit Number (to be filled in by Co.) (608) 266 - �t0 / Department of Commerce 3 (O Sanitary Permit Application State Plan I.D. Number l In accord with Comm 83.21, Wis. Adm. Code, personal information you provide O V, / ' ( W-AAJS • I& may be used for secondary purposes Privacy Law, s15.04 I m / project Address (if different than mailing address) I. Application Information — Please Print All Information (S7 /- tv 1 Property Owner's Name OCT 2 7 2 0 0 4 Parcel # Lot #I . Block # / 03 -WD Pro eriy Owner's Mail 9--Address I X U U U N I Y Property Location O32 • i ot, 2 - to - UCiD ZONING OFFICE ' City, State Zip Code: Phone Number � /,, /4, Section (circle gam) T N; R 9 E or&y ' II, Type of Building (check all that apply) ❑ 1 or 2 Family Dwelling — Number of Bedrooms Subdiviei name CSM Number X Public /Commercial — Describe Use ❑ State Owned — Describe Use ❑City_❑Vill e I hownship of III. Type of Permit: ( Cbeck only one box on line A. Complete line B if applicable) A, � New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B• ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS Sys . tem: Check all that a Z A 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- (around ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dis ersal/Treatm t Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area equ rid Isf) ` Dispersal Area Proposed (sf) System Elevation 3S 7 S) C VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units l4—�QD Concrete Constructed Glass New Existing r� Tanks Tanks 1• Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, a&540 respons' 'lily for installation of the POWTS shown on the attached plans. Plumb is a Pri Plumbe ' MP/MPRS Number Business Phone Number L Plu tier's ress Street, City, State, Zip Codef 700 , VIII. Colin /De arttie &Use Onl X Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued I uin Agent Signa (No Stamps) Surcharge Fee) q� ❑ Owner Given Reason for Denial 25v-- (} , 2$ 2M IX. Conditions of Approval/Reasons for Disapproval � �{A11/1�2 / C.t� ^ SYSTEM OWNER: 3 S "`° , a� 1 Septic tank, effluent filter and <A-. t S dispersal cell must 811 42 §ervi�gd t maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than SM x 11 inches in size SBD -6398 (R. 01 /03) i f t , i : r I 0 a G® Safety and Buildings commerceml. ov 4003 N KINNEY COULEE RD g LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 isco nsin www.commerce. o Department of Commerce www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary October 15, 2004 CUST ID No.224263 ATTN: POWTS Inspector KIM A O CONNELL ZONING OFFICE K.O. CONSTRUCTION ST CROIX COUNTY SPIA 504 3RD AVE 1101 CARMICHAEL RD OSCEOLA WI 54020 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/15/2006 Identification Numbers Transaction ID No. 1068781 SITE: Site ID No. 690812 Dave Wachter /Rainmaker Please refer to both identification numbers, County Road V above, in all correspondence with the agency. Town of Somerset St Croix County NW1/4, NW1 /4, S18, T30N, R19W FOR: Description: Commercial Non - pressurized In -ground POWTS Object Type: POWTS Component Manual Regulated Object ID No.: 986041 Maintenance required; 266 GPD Flow rate; 115 in Soil minimum depth to limiting factor from original grade System: In -ground POWTS Component Manual, SBD- 10705 -P (N.01 /01); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following' conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "In- ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD - 10705 -P (N.01/01). • The leaching chambers must be installed in accordance with the manufacturer's printed instructions, the plan approval and Comm 83, Wis. Adm. Code system sizing criteria. If there is a conflict between the manufacturer's instructions and the plan approval, the plan approval and code requirements will take precedence. • The addition of chamber end caps in each trench will extend the trenches out to 74.1 feet long. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • This approval does not include plans for the general plumbing systems or sewer piping leading to the septic/holding tank that may be required for this project. See section Comm 82.20, Wis. Adm. Code, to determine if plan submittal and approval is required. P.GvL. tp KIM A O CONNELL Page 2 10/15/2004 • Comm 83.22(7) - A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Gerard M. Swim Balance Due $ 0.00 POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm jswim @commerce.state.wi.us WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 RECEIVED OCT - 6 2004 SAFETY & BLOGS DIV, s A 4Ci,Ilzd AAA) Z - - J "" .i;Att1►d;Lb1�ET N� BUILDINGS ,OJESry�llo J�u,4s'r�.tvT r/� pENG ORR F ,N QW &�� LLE G� 17k�s,o.v �L sd,0 /D 7D6 'IV, p� 1) J 77x/ l y _ a 1 41 i N j b ,.r Q d rl T < I cr r.• II � '� ► Ivl kc, � • ♦, ••. I o . i to . I n •, d ► CD t7' O 1u n �I r \ i I G cn b� Page POWTS OWNER'S MANUAL & MANAGEMENT PLAN of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity,_, t . , ` el . 0 NA Permit # Septic Tank Manufacturer ,tr f > 0 N / DESIGN PARAMETERS Effluent Filter Manufecturer ° � ' kt 0 NA Number of Bedrooms )4NA Effluent Filter Modei -­ „ Q NA Number of Public Facility Units 0 NA Pump Tank Capacity g al Estimate flow (average) Pump Tank Manufacturer. fytj4 ZZZ Dusi©n flow (peak), (Estimated x 1,5) l Pump Manufacturer ' ONA elide Soil Application Rate gal/day/ft' Pomp Model -� NA Standard Influent /Effluent Quality Monthly average” Pretreatment Unit t;" + ` ' ' NA Fats, 011 & Grease (FOG) 530 mg /L 0 Sand /Gravel Filter C3 Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L 0 NA 0 Mechanical Aeration 0 Wetland Total Suspended Solids (TSS) 5150 mg /L 0 Disinfection C] Other : 1 j Pretreated Effluent Quality Y average 9 e Dispersal Cells) 0 NA Biochemical Oxygen Demand (BOD 530 mg /L �dIn•Ground (gravity) D In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L 19 NA O At-Grade 0 Mound Fecal Coliform (geometric mean) 510' cfu /100ml 0 Drip -Line 0 Other; Maximum Effluent Particle Size Y in dia. 0 NA Other; 0 NA { Other; 0 NA Other: 0 NA "Values typical for domestic wastewater and septic tank effluent, Other' 0 NA MAINTENANCE SCHEDULE �' f Service Event Service Frequency Inspect condition of tank(s) At least once every; monthl8 ra lM um 3 years) 0 NA p ars M , Pump out contents of tank(s) When combined sludge and scum equals one - third (4 of tank volume 0 NA Inspect dispersal calls) At least once every; mont !s) (Maximum 3 years) 0 NA y ear(s) month(s) . �' a „” Clean effluent filter At least once every: ears) O NA Inspect pump, pump controls & alarm At least once every: O monthls) a NA 0 year(s) Flush laterals and pressure test At least once every: C3 month ($ ) .� ;:i,. • .. - r`h 0 earls) Other: At least once eve 0 monthls) every:. 0 NA 0 ear Other; Q 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 Inspeotor, POWTS Maintalner; Septoge Servicing Operator. Td( inspections must Include a visual Inspection of the tank(s) to identify any missing or broken hardware, Identify any cracks or Ivor- measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. fhe dispersal call($) shall be visual) inspected to check the effluent levels in the observation pipes sn to oh eo k''-tpr;any pondinj Y p 4l -. of effluent on the ground surface, The ponding of effluent on the ground surface may indicate. a failing co , trdition'and requires thv 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 entir, contents of the tank shell be removed by a Septage Servicing Operator and disposed of In accordance with chapter NR 1 1 Wisconsin Administrative Code, i:. All other services, including but not limited to the servicing of effluent filters, meohanloal or pressurized aorne nents, pretreatmer ; .snits, and any servicing at intervals of $12 months, shail be performaa 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, GMW (4101; Pogo START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products ,or,of(her,chamicu.. that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contur -t, 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 exoesp wastewator will L, discharged to the dispersal cell(*) in one large dose, overloading the cells) and may result1 basokup-of Wr WO disahargo v effluent, To avoid this situation have the-contents of the pump tank removed by a Septage Servicing Operatgr prlorlto ratofjwv power to the effluent pump or contact a Plumber or POWTS Maintainer to assist. In manually "operating; thc' pump controls restore normal levels within the pump tank, Do not drive or park vehicles over tanks and dispersal ells. Uv not drive or park over, or otherwise disturb or compact, thu w within 16 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 to t POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; dogreasers; dental flo *s; diapers; disinfectants; foundation drain (sump pump) water; fruit and vegetable peolings; gasoline; grease; herbio1den; 1,MQat�,aaraps; m0.100110ns; pil, 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 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,fel�d • The contents of all tanks and pits shall be removed and properly disposed of by a Septaga,;9ervioing:QPerator. • After pumping, all tanks and pits shall be excavated and rontvvod or their covers rem9v9d and the void space flllod rnu soil, gravel or anothor inert solid 111awrial, CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following moaswes have been, or must . be.taken,. - to.pftavid@,.a,00de compliant replacement system D o A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil ob *orption 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 w result in the need for a new soil and site evaluation to establish a suitablo replacement area.' Replacement systems ;nog . comply with the rules in effect at that time. 0 A suitable replacement area Is not available due to setback and/or soil limitations, $erring advanaes technology a holding tank may be installed as a last resort to replace the failed POWTS.-1 �^�°y �,,­ 0 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 tani, may be installed as a last resort to replace the failed POWTS. O Mound and at -grade soil absorption systems may be reconstructed in place following 'removal of th9..,,010mat at the infiltrative surface, Reconstructions of such systems must comply with the rules In o'ffect < <WARNING> > M ....�,- �.. 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.REBULT, RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE, ADDITIONAL COMMENTS ... :, tCYil�:�h'rryiYt '( t ill. *.,,re.'a' rxr;►�rtlilULM Q! "]�r11tt1�'r`t..,t, ,,: ,_ POWTS INSTALLER POWTS MAINTAINER Name Name Phone Phone -, SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REG LATORY AUTH RI ,,, } Name Nartle Phone Phone 1 ,. This avv ment was dratted In compliance with chapter Comm 83,22(2)(b)(1)(d) &(f) and 03,6411), (2) - & (3), Wisconsin Administrative COd .A RECEVFD Wisconsin Department ofCommerce SOIL EVA UATION REPORT Page Of Division of Safety and Buildings ST.CRUI/\ I r in acc anNgYW ;mp 85, Adm. Code County Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information Re 'ewed by Date II Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 2 I Property Owner Property Location 1 Govt. Lot 1/4J/1 1/4 S T N R (o MW Property Owner's Mailing Address Lot # 1 81 ' o Subd. Name or C A�fF L l City State Zip Code Phone Number ❑ City ❑ village M Town Nearest Road ( ) New Construction Use: ❑ Residential /Number of bedrooms Code derived design flow rate GPD ❑ Replacement Public or commercial - Describe: - rat, j" Parent materia Flood Plain elevation if applicable ft. General comments and recommendation: s m l- 9 ,/, 9s F71 Boring # E] Boring Pit Ground surface elev. /d,? 95 ft. Depth to limiting factor > /lam in. Soil Applicati on Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 " Eff#2 s / _' 9 4 S 14, — D CXV D Boring # E] Boring 0 pit Ground surface elev. JW, 75 ft. Depth to limiting factor y / /S in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ALI_ I _ s - _ hl * Effluent #1 = BOD > 36 220 mg/L and TSS >30 < 150 mg/L r uent #2 = BO13 < 30 mg/L and TSS < 30 mg/L CST Name (PI Print) Signature CST Number Z Z�z2iQ Address Date luation Conducted Telephone Number i y Property Owner 0 Parcel ID # Page of 17 Boring # ❑ Boring Pit Ground surface elev. ft. Depth to limiting factor > in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eif12 6 y ad ds - - 9 / p .o F Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Applicatl on Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mgA. * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD -8330 (K07 /00) - y: 0 t 310 1 d e � � � r .al -�, N2 e�. ST CROIX COUNTY _ SEPTIC TANK MAINTENANCE AGREEMENT AND OWNS HIP CERTIFICATION FORM Owner/.Buyer LA Mailing Address l 4 Property AddreSs (Verification required from Planning Department for new construction) City /State ° —�� Parcel Identification Number r-Z2 1 ;2 � LE GAL: DESCL Ii'TION Property '/a, Sec., T�N -RW, Town of Subdivision , Lot # Certified Survey fllap # /U , Volume , Page # Warranty Deed # Y3572&o , Volume gos ,Page # 20 9 Spec house ❑ yes >�no Lot lines identifiable ,eyes 0 no SYSTE 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 wastewater disposa I 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 ti year expiration date. 4 SIGNATLT,E Of, .,�,PPI,ICANT ATD E L OWNED CERTIFICATION 1 ( %vc) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above by virtue of a rranty deed recorded in Register of Deeds Office. / d SIGNATURk; QF 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 DPRW2 r' \ n P p is •` - 1 Z. � = ^ _ IL ICHQEL I Q i u B WOkfF 'S tA IA a � ._.• p1 gN R J Q � t- E �A 00 IL a 10 U --` OM a + • 2 c - <. • 1 o �,v RONSIER RT H n ROCHFORD 651 ' . uj r m . N Z y F.• I� g .•. =a 4 0 PRW3� ..., , T 4" - V • LOS 4 / ,o PRW30 f / M SLOPE N N INTERCEPT W O f sp - 3E o MICHAEL S M c 'p i "s F ; O Inn Z M J W MICHAEL v a F- w e N Q W 0A D N W �$s SLOPE N INTERCEPT CURVE PRL17 i f � i ci P.I. 19+724.595 N N - 143117.155 E = 384630 . SIO 68 0 7 R 230.000 m T 157.379 m L 276.037 m .°Rfzw� f s E 48.690 Nw X . U O \ 5 - " t � - z. ter:. '' •' -''' v o - ,.r r i 0 - RE I S ION DATE DATE SCALE. a vz7i9s Z o GRID FACTOR 0. 999905 — a F ILE N d6 1 5590D2 ]'15594 40B 14 .. .s y SLOPE �. � �' "r�.b- - =� 1.:• t INTERCEPT / ERQNTIER t 1 COMMHNICATIO B.LEVERY,:. I ; I ,' x .�, 1@3 JP ,f �t i 'r} ''• i AP ALtOW h. /1 TEMPORAR M&B \�" INTEREST st •.' RTY MATCH L:1'NE tS ' 1K':;10 +720 SEE SHEET 4'.j N t CAUTION ;1 4 'k•�:.'';. J 3 TNiS PLAT IS FOR ILLUSTRATIVE PURPOSES Py, NL •. O �, ' »f '" t. f ix' 'ff f OY. DEEDS MUST BE CHECKED { / TO DETERMINE PROPERTY BOUNDARIES. ..,, NOTE "B RING CONVERSION AND GRID CONVERSION" PLAT BEANINGS ARE ORIENTATED TO THE WISCONSIN air `� �� - >• ^{ T~ Y• .:'� COORDINATE SYSTEM (CENTRAL ZONE) WITH O DEGREES 7EApRARY• 0 MINUT'�EES O SECONDS BEING GRID NORTH. PLAT DISTANCES ARE GROUND LENGTHS AND CAN BE CONVERTED �iMTERES " 12 TO GRID L NOTHS BY MULTIPLYING DISTANCES BY 0.999906 / L — / f/ / ST. CROIX ELECTRIC \ s -< COOPERATIVE J 125 HWY: S.T.H. 64 FEDERAL PROJECT NO: COUNTY: ST. CROIX STATE R/W PROJECT NO: 1559 -08 -21 SHEET NO: 4.9 M -- WisDOT• MSNTlS St. Croix County Map Output Page Page 1 of 1 St. Croix County Mappin 745A .. VR X0 3/116 14561411 c; � 391.38 2 a i t , `t 745E 97,8 Ci T2 Xa z CLO w ` 623,98 745A -10 ' 57247 LOT1 .. + 745 38 3.83 CSal N ' 11E 1 1roL sPG 14M s 7451 " 14031353A 1407/537 LOT1� LOT1 7460 7460 746A -1! cSM%VL eP6 2270 �o 1433/116 SW1 /4NW1 /4 z, ' /�,r J Legend fuf�ncfp� BclfMaks St. Croix County Planning Department °i°d1i 1101 Carmichael Road ceroye d cxrvey Maps Hudson, WI 54016 0 F Crls Phone: (715) 386-4674 pcmd O pa.ro.ad 17rai rage DISCLAIMER: The information contained on this map is advisory. Map Streams accuracy is limited by the quality of the public records from which it was oaf ,,, prepared. It is not intended as a substitute for an accurate field survey. Perferra orean kn*fml Mnl dream AERIAL PHOTOS : Aerial photography is date - sensitive. Features that exist presently in the County may not be present in the photos. http: //69.5 8.147.26/ servlet /com.esri. esrimap. Esrimap? ServiceName= StCroixOV &ClientVers... 10/28/2004 ex 1417/629 Y y t •,1� ; ,i � .,r f� 6 �� x. 7 f S Q 1403/353A LOT1 746A -10 } CSM VOL 8 PG 2278 AS BS 41 1433/116 SW 1 /4 -NW 1/4 746A I '03 3209 DOCUMENT NO. TNIs $PACs RsasRV[D Pon RLco "o DATA RO WARRANTY DEED 4 3 5 .no "STAT(w BAR OF WISCONSIN FORM 2 -198f i 1 � _!� REGISTER'S OFFICE f! ST.. CROIX CO., WI !� ' ( Rec'd for Record ........... . .... .............. ............................... . ....._._... ndor}. Lockrem .and. - Linda.. L.- •• Lockr�,e� •.•..... -, I lAr�r( 15 1 husbansl:,.and .:.. ....................... ; L. ' as 10:30 PM conveys and to `..... .David Patricia A. Wachter, • as. • hus €3n�d, and wife C R"Ww of Deeds ...... ............ .. ....... ........ ........... - - f .••.,,• I RLTURN TO � Century 21 ......... ..................... ........ Box 416 1 the following described real estate in ..........St ... CJZQ.i7 . ..... County, Somerset – i- Wi– = = State of Wisconsin: Part of W of N W k of Section 18 -30 -19 Tax Par cel No: .............................. described as follows: Lot 1 of Certified Survey Map filed 'i June 311 1983 in Volume 11 page 1292 (No. 62). TRANSFER FEE f o �i is not !j This ............................ homestead property. (is) (is not) ;j Exception to warranties: recorded easements and rights -of -way '1 Dated this ............... . l '........................... day of ............... March........... 19 88.... ......!!.........(SEAL) ... . ...... SEAL) SEAL) 7 L ndon L. Lockrem Linda L. Lockrem ................................... ............................... ........................ ....... ...............(SEAL) .......... ............................... .........................(SEAL) .................. • �i AUTHENTICATION ACKNOWLEDGMENT Signature(s) ............................................................ STATE OF WISCONSIN as. .......................... ...................................................... St Croix ... ........................County. authenticated this ........day of.., ........................ 19 ...... Personally came before me this .... llth ... day of _......... rizh........... 1 19.04 ... the above named .:............................................... ............................... 1, ndon L M•4 Lockrem and Linda L. Lockrem X ..... ........................................................... ----•• .................................. ............. .... •••- ••-- _....• ---....................._.............._......... ........----- •---- •............ i TITLE: MEMBER STATE BAR OF WISCONSIV r. ... (If not, authorized by 1'• tome known to be the person s .......... who executed the foeegoiag in rument and acknow the same. • THIS INSTRUMENT WAS DRAFTED BV " �9 i1? >a Wa d. . � ..................•. ............... .. • John Walsh ........................... .... ......................................................... .....- - t -C O • tv Wi . �. -r . ,... Notary Public .............5. .lx.......- .Co n .. s. (Signatures may be authenticated or acknd�elf B�tlr� 1 ',y j,j Commission is permanent. (If not, state expiration are not necessary) 'ri l d ate: ............... .. a' . , Dec.•...1D .... ...................... 19..89..) '! V JIJIa[^ - I� •Namaa of Dss'sona ai=nlni Is any caD %aeit7 should be typed or printed below their signatures. WARRAN•1T DEED STATE BAR OP WISCONSIN Wisconsin I•rsal Blank V.. FORM 270. 7I— IV12 Mijuapkse. Wis. I .s s og 3559.04 ST CROIX COUNTY CERT /F /ED SURVEY MAR LOCATED IN PART OF THE W 1/2 OF THE NW 1/4 OF SECTION 18, T 30 N, R 19 W, TOWN OF SOMERSET, ST. CROIX COUNTY WISCONSIN. NORTH OuARTER COMACR SECT/oIV /9 -30 -/-9 • - � CO!/NT Y MONIJMEN T NORTHWEST CORNER THE NORTH L /NE OF TH .- NORTHIrYEST OuARTER OF SECT /ON E/GHTEEN SECT /ON /8- 30 -1 COUNTY MONl1MENT N 90 00' O0" E. 1153.98' ( RECORDED AS: S. 87° 41' 32" E. 1153.88' ) OWNER PLATTER DONALD A. B SALLY A. MICHAELSON DAVID WACHTER RURAL ROUTE 1, BOX 148 RURAL ROUTE 1, BOX 199C ip ;' 7g• :v ST. JOSEPH, WISCONSIN 54082 SOMERSET, WISCONSIN 54025 N NOTE- PROPERTY CORNER LIES : 76 54 0.80' FRAM cy N N THIS EXiST/NG P /PE. _ _• n qt 63- S. 6 �4 3R9c�- S Tgo 341' /3" F b vi +� ocb �v 6 2 I h o CORp 4 T E3 ED DETA /L FU ` Q' 2' CURVE / - 2 45' E) pa: © D = O° 27' 15" l• ' 0 R = 5804.58° S. O° 48' 26" E. 51.52 S /'S /' Ld L = 46.00' 1l C = N. 24° 21' 37.5" E., 46.00' S. 89 11' 34' W. 50' yI T = N. 24° 35' 15" E. 0 ZI N. 24 08' 00" E. of LOT 1 s 217, 800 SO. FT ( 5.000 ACRES) 'n: Q�I N EXCLUDING R/W N 256,249 SO. FT. (5.61513 ACRES) I - 110 INCLUDING R/W W, Z WI 3 (� I � 0 X 3 0 00I Z LEGEND �,��,, @�• vii _"' !f I N O I "X 24" IRON PIPE SET O QD WEIGHING 1.68 LBS. /LIN. FT. B� N. 8° 11 34" E. 0 1" IRON PIPE FOUND ?J ' o THE NORTH LINE OF THE NW 1/4 c. jr ti V1 0 OF SECTION 18 -30 -19 IS ASSUMED TO BEAR N. 90 00' 00" E. Nj V I SCALE ONE INCH EQUALS ONE HUNDRED FEET WI iD 1 O 100' 200' 300' ai APPROVED > ° W E �t5�'o N+Siy' JUN 1 1983 N1 S jo ALLEN C. y I NYNAGEN ST. CROIX COUNTY Fi e+ �. .I407 COMPM11J:NSIVE PARKS PLANNINO Amp ZONING COM/.YITM HUD 'SON, I WIS. ( 1 v Wfl sUR`'� SIGNED e ?LAr/d^V- DATED A 1 1 10 S',9 fosse i � ALLEN C. NYHA N R.L� 07 VOLUME r , EDGE 12 CERTIFIED SURVEY MAPS this instrument was drafted by ken hodk(ewicz. JOB N 83-10 ST. CROIX COUNTY, WISCONSIN Parcel #: 032 - 2062 -50 -000 03104/2005 08:24 AM PAGE 1 OF 1 Alt. Parcel #: 18.30.19.745H 032 - TOWN OF SOMERSET Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * DAVID A & PATRICIA A WACHTER WACHTER, DAVID A & PATRICIA A BOX 249 SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 5432 SCH D OF SOMERSET SP 1700 WITC i Legal Description: Acres: 3.900 Plat: N/A -NOT AVAILABLE SEC 18 T30N R19W NW NW THAT PART OF CSM Block/Condo Bldg: 5/1292 EXC PT TO HWY PROJ 1422/458 ASSESS WITH P746C Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 18- 30N -19W Notes: Parcel History: Date Doc # Vol /Page Type 04/29/1999 602205 1422/458 AD 07/23/1997 805/209 07/23/1997 727/228 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 11115 61,900 Valuations: Last Changed: 07/24/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.900 52,500 0 52,500 NO I Totals for 2004: General Property 3.900 52,500 0 52,500 Woodland 0.000 0 0 Totals for 2003: General Property 3.900 52,500 0 52,500 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 I Parcel #: 032 - 2062 -80 -000 03/04/2005 08:26 AM PAGE 1 OF 1 Alt. Parcel #: 18.30.19.746C 032 - TOWN OF SOMERSET Current ,X_ ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * DAVID A & PATRICIA A WACHTER WACHTER, DAVID A & PATRICIA A BOX 249 SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE SEC 18 T30N R19W SW NW THAT PART OF LOT Block/Condo Bldg: 1 CSM 5/1292 EXC TO HWY PROJ 1559 -08 -21 ASSESS WITH P745H Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 18- 30N -19W Notes: Parcel History: Date Doc # Vol /Page Type 04/29/1999 602205 1422/458 AD 07/23/1997 805/209 07/23/1997 727/228 2004 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 01/23/2001 Description Class Acres Land Improve Total State Reason Totals for 2004: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2003: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00