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HomeMy WebLinkAbout032-2149-50-000 �a2 11 'V 0 d C ° �D C W I fr !A T '0 T. 3 Z 0 CO m W 3 Z O w C N W e • N c y N c A w n C. Ion ° CL cr CL c ° �c R c �_ c 3 3 O m 7 0 C7 o p v v 9 a c m (n D (o D y m (o D (a D I C .'= 3 a a IW a a 0 0 s 0 0 N N a v CT O CL o r ca O y CD O y N O m ca C N• , ,y.. m ct z z 000 o 0 (n 0 O � O cn D1 O 3 O � 3 CA ca O 3 .. 3. a Q 0 'vvvN v lu m CL n co Z o w � ( 0 Q Q z " N w m w (0 3, a Z C Z CD ,� —1 ca > > A Z w v a A G j 7 Z w N CL z o ;o G w 3 tO w z w Q a I CL Co "" :3v = -{ y a(n —O» 2 -i D ,. ^ N CD g 0 Z3 O C 7: O. (D CD g N Q O C S O. v v_' :E <c 3 rn a_ a' f >>:E <c 3a' v _ 3�CD mC o c�w �C c a =c CD m `�n� w pa�C - C Dm d d c m��' f E m�� £ C CL CL �,a ti = 0�$? -�� y a a (D ag m CD y 0 N N N n N ° -1� -O a Cl) O N w 7 7 (gyp U) fn 7 (p d >> m y CD CD O O 0 A O y CD CD 3 0 �-- D m a 3 0 _m m =' a N (A (a Q f3D y' C. C N y (O f3D y a a ' f D E; CD y 3 (D g »= c 3 mc�m'cS (°3.' ° ` S. c ys �. Q (Q N c R. Q (Q y C Q ,y.. C. 7 y "" C. 7 N 0 2s 3 7 aa (D N D 3 7 da(D N y q �Of� Q3 p , cr- fit C- O y C 0 0) A d to C 0� C m m m a m m w Cl. o �I o 0 (D N D V 69 69 O O CD - O O a N Wiwonsin Department of commerce PRIVATE SEWAGE SYSTEM County: suety t3,d DMS INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal irdortnation you provics may be used for secondary purposes [Privacy Lava s.t 5.04 (t)(m)). 384263 Permit Holder's Name: City ❑ Villa ❑ Town of: State Pn ID Nom M & G Inc. Mike Germain, Somerset Township CST SM Elev.; 1 Insp. SM Elev.: BM Description: Parcel Tax No.: ao.o Ic o. - C' Z " P t,c_ = % l f u �", cs TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION 85 HI FS ELEV. Stptic hmar Q 11,13, 1 1L ,11 &0 'D Dosing Aeration Bldg. Sewer Ho�din St/ Ht Inlet 95 TANK SETBACK INFORMATION St/ Ht Outlet • (`� fl3, IANKTO P/L WELL BLDG_ ventto ROAD Dt Inlet Air Intake SF tic �� > NA Ot Bottom "M An y `" NA Header /Man. I 100.3 9 • 1o,fia leo 1= .ration NA Dist. Pipe ►2 .1 ` �lding Bot. System 12.2D .6I JMP / SIPHON INFORMATION St C OQ @" VD Gra 03. (r ' lanufacturer mand ST 5�1 (0 7- todel Number GPM DH Lift Fri m TDH Ft ea .'orcemain ngth Dia. Dist.ToWell SOIL ABSORPTION SYSTEM BED / TRENCH I Width Length , N Of Trenches PIT NO. Of Pits Inside Oia. Liquid Depth D IMENSIONS 3 bB.�S DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manu acwrer: INFORMATION Type O CHAMBER Moe Numb }S ' Qp 1 �- OR UNIT Q to System: t DISTRIBUTION SYSTEM He er / Mani old Distribution Pipes) x Hole Size x Hole Spacing Vent To Air Intake Length Dia leng 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 Mulched Bed /Trench Center Bed /Trench Edges T Y s es No 1' / COMMENTS: (Include code discrepancies, persons present, etc.) MA" A, ZaDZ . Location: 2349 County Road I, Somerset, WI 54025 (NW 1/4 SW 1/4 2 T31N R19W) - 023119 -Lots- 1.) Alt BM Description = 2.) Bldg sewer length = 30 1 - amount of cover =18 . u 3 ) �p ,Q A -l Plan revision required? ❑ Yes No �� ZA J _ Use other side for additional informatl n. SBO -6710 (R.3/97) Date Inspectors Signature Cert No i i3 C � 5 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 NV i sconsin Personal information you provide may be used for secondary oses u Madison, WI 53707 -7302 Department of Commerce p it ltd f t (Submit completed o county if not [Privacy Law, s. 15.04(1)(m)J state owned.) Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. County State Sam Permit Number 11 Check if re ' r v plication State Plan I. D. Number Lk- P 2 � 3 ,,, k"\\ z , /� I. Application Information - Please Print all Information Location: Property Owner Name i `�•� Property Location 1 RI-CEEVED e ••r 1/4 x(/1/4, S T N, R/ (or) Property Owner's Mailing Address ^: ; Lot Number Block Number 7 4P ST CAOtX �� g dir. /Vf? City, State Zip Code Phone NumbeKXJNTY Subdivision Name or CSM Number ZONNdG r e t—al Aup CIO IV II. Type of Building: (check one) ❑ City 90 1 or 2 Family Dwelling - No. of Bedrooms :�_ _ - ❑ Village ❑ Public /Commercial (describe use):_ 1$TOWn of ❑ State -Owned , — Nearest Road Parcel Tax um er(s III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) - - A) 1. M New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System $) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) ® Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: Z Z pia - ,l,- 4 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4, Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) C O Q .i Elevation / O V/ V 2 , 0 6 0 VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks Ea ❑ ❑ ❑ ❑ 0 e VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the att hed plans. Plumber's Name (print Plu s Signature (no slam ): M S Business Phone Number ' 7 g l Plumber's Address (Street, City, State, Zip ode) C= 7 f ,77 �G IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) Approved ❑ Owner Given Initial Adverse Surcharge Feed /� Determination ZZ!� ZS p X. Conditions of Approval /Reasons for Disapproval: 64 r - fauuer S�aU be itiS�ae� rr Sai S� >q0 �e %w pv;9�v�a/grAaF� ct�ovy fzN��rw. J�►� "S ;Y51 <5 Siyn�� �✓ a /t"e� aw p %oOSc� G42..f< i� At e orea s --a -A s ;S a ei' y le s'delce et/ /owea/ e,, `(fie 24j'e WtAel a ✓ c e Ger• �, s e / t�h SBD -6398 (R 07/00) i - � r i —r— n , 1 r J 1 , 1 f 1 I I IL i r _ YAAl s L I j : t J J i J r J I I , k } i , i , lJ1E. z2 1 7 5�/ t � � _ + � _ ; _ _ _� . �. _ _ _ __ __ ___ _ � � fi _ __ ___ -- —- _ �_ ._ —t— — }— 1 ___ _ ._ — I 1 � � � i F — + ' — - —*— r � � fi r �- � � -� _ - - -- --�__- t - -, -- - t __ ._ _ . _ � � � I j � _ ' _ _ __ _-� -- _ � � _ _ - -- -- - ,� _— -- ((( � } .�_ _i . -. .. � _.__ ... 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IF �- t � . , i T _E I � o � � � � � � � � � . �_ t � � � 1 , j ! — r —. _ _ _._ _ _ _ ,. i ` � t i I � � � t { �_. �. _• - - t � s � t }- I � � i I � t I 1 � �` —} _ } I I � � � � — 1_ � � �_ � -- f _ _� __�_ __ - _ fi t -- _ . -- - _ - ;_ _ - - - -- - -- -- -_ - -- _.__ _ __ _ _ _ ___. _ �._ r � � + �.. � _ . � + T. ,. .. _p ,_ + £ i ; � � -- - - - -- - _� - -- - —_ - - — - - r- - _ _ . _ � — - __ + ' � � t .. _. _ ... __ _. .__ i _ r j + � � � -- � �� 1 � _ 1 i — - -- - -- � -- 1 _ — — — — .. � _ _ — � _ _ �� � f � � — — _. _ — __ _ —- — _ — - -� , -- —� I � t 1 � � � � —� — __ {€ � I � } � t � :_ ' -- __ __ , __ _ _ , t t � -t _, T -- _..___ t a _ { � � � � � f— } � � t _ _ o � a — — __ — ,- ; a s I . 1 _ _ i i 1 I � � ' � � � � i � (, i � � ; i. 6 , � r s � � i ) t � -, f �_ _ � � + }- a 3 1 1 i a_ y � a t + i 1 ` j i _i i__ I_ � 1 � a t � ' 1049 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Tom Schmitt Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. Please print all i fop.? ed y Date Personal information you provide may be u f s6d.ry purposes (P ' acy 15.04 (1) (m)). s 6 Property Owner property Location M & G Inc e� Govt. Lot na NW 1/4 SW 1/4 S 2 T 31 N R 19 W Property Owners Mailing Address Lot -# Block If Subd. Name or CSM# 1359 Awatukee Trail '� 15 na Grandview Estates City Stat od orgl"N (_f City _J Village a Town Nearest Road Hudson WI 6 71 �71 Somerset Cty.Rd.l New Construction Use: y_j Res" t crf�edrbgrfis 3 Code derived design flow rate 450 GPD _j Replacement Public or t i I ti rib e: Parent material Outwash Flood plain elevation, if applicable na General comments and recommendations: Suitable for a conventional system with a 0.7gpd /sqft rating. Possible system elevation for Area (,step trenches, (high trench) 99.00 (low trench) 97.68. Based on a 11 % slope. Boring # I Boring V1 Pit Ground Surface elev. 102.00 ft. Depth to limiting factor >96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -6 10yr3/3 none I 2mgr mfr Cs 1f .5 .8 ✓ 2 6 -12 10yr4/4 none sl 2fsbk mfr cw 1f .5 ✓ .9 3 .1\20 10yr4 /6 none Is 1 msbk mvfr gw - - - -- .7 ✓ 1.2 4 20 -96 10yr5/4 none ms Osg ml - - -- - - - - -- .7 ✓ 1.2 36 , z Fi_1 Boring # I Boring �f✓ Pit Ground Surface elev. 102.59 ft. Depth to limiting factor >107 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 1 0 -10 10yr314 none sl 2mgr mvfr cs 1f .5 ✓ .9 ✓ 2 10 -27 10yr4/4 none sl 2fsbk mfr gw if .5 .9 ✓ 3 27 -44 7.5yr4/6 none Is 1 msbk mvfr gw - - - - -- .7 / 1.2 / 4 44 -48 °� 1Byr5S4 none Cos Osg ml - - -- - - - - -- .7 , 1.6 ✓ Ai 5 48 -107 10yr514 none ms Osg ml - - -- - - - - -- 7 ✓ 1.2 U rr * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < mg /L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt `-� 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 586 Valley View Trail, Somerset, WI 54025 5/21/01 715 -549 -6651 i Property Owner M & G Inc Parcel ID # Page 2 of 3 3 ] Boring # I Boring 1✓ Pit Ground Surface elev, 99.06 ft. Depth to limiting factor >99 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -11 1Oyr3/3 none sl 2msbk mvfr cw 1f .5 ✓ .9 ✓ 2 11 -24 1Oyr4/4 none sl 2fsbk mvfr gw if .5 ✓ .9 3 435 1 r4! - - - - -- ✓ Oy 6 none Is 1 msbk mvfr gw .7 1.2 4 35 -99 1Oyr5/4 none ms Osg mi - - -- - - - - -- .7 ✓ 1.2 c F j Boring # - I Boring _Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rood GPW in. Munsell Qu. Sz. Cont. Color Gr. Sz, Sh. *Eff#1 *Eff#2 17 Boring # J 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 GP 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 mg/L * Effluent #2 = BOD <30 mg/L and TSS <30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or „AP.i morar;ol :,, �., alrarnora f —t n1-- — thA .Ia.. rf—f of F0SL7AA_1 I ;I — TTV AOR_7FA_R777 I I p �.qe 3e-�3 2,o7 Jf7c -fir a 4 a" Pvc CL., /0 -6, 00' 671 - /0,? lv j 4p P3� OL a9� X3 + q .� c i q Y 13S A-,�aAt e,e - r,-m , / Ca ,gym oV 7 !-of ,�— 8ra- diet i ZSAa ?S <�710 SW -vial lYa1 Sys 52 3t/Z( ,�t�� Page of MANAGEMENT PLAN This Private Onsite Wastewater Treatment System (POW'rS) has been designed and is to be installed and maintained in according to Comm 83, Wis. Admin. Code, the in- Ground Soil Absorption Component Manual for Private (hisite Wastewater Treatment Systems (SBD- 10567 -P; June 11, 1999), 1. This POWTS has been designed to accommodate a maximum daily now of IJ,SO gallons of domestic wastewater -per day. The quality of influent discharged into the POWTS treatment or disposal component shall be equal to or less than all of the following: a monthly average of 30 mg/L fats, oil and grease a monthly average of 220 mg/L BOD 5 a monthly average of 159 mg/L TSS. Wastewater shall not be discharged to the POWTS in quantities or qualities that exceed these limits or that result in exceeding the enforcement standards and preventative action limits specified in ch. NR 140 Tables 1 & 2 at a point of standards application, except as provided in Comm 83.03 (4)m Wis. Admin. Code. 2. The owner of this POWTS is responsible for system operation and maintenance. The following maintenance shall occur within three (3) years of the date of installation and at least once every three years thereafter: I . The septic tank shall be pumped be a certified septage servicing operator, licensed under s2.81.48, Wis. Stats, unless inspection by a licensed master plumber or other person authorized to make such inspection, finds less than (1/3) of the tank volume occupied be sludge and scum. More frequent pumping may be necessary to prevent solids from exceeding one -third (1/3) if the volume of the tank.. Wastes shall be disposed of by the pumper in accordance with ch. NR 113 Wis. Admin. Code. At each pumping the pumper must visually inspect the condition of the lank, baffles, rizers, and manhole cover and verify that any required locks are present. 2. The soil absorption component(s) shall be visually inspected by a licensed master plumber, certified septage servicing operator or POWTS inspector. Inspection shall check for evidence of discharge of sewage to the ground surface and for ponding of effluent in the distribution cell. 3. The tank filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. The filter cartridge shall not be I v Y removed unless provisions are made to retain solids in the tank. Cleaning of the filter at more frequent intervals may be necessary. I 4. Any pump, alarm or related electrical connec tions shall be visually checked for defects and tested to confirm that they are operating properly. 5. Reports for all system maintenance shall be submitted to St. Croix County Zoning in accordance with Comm 83.55, Wis. Admin. Code. 3. Defects or malfunctions identified during maintenance described in item #2 above shall be repaired in conformance with Comm 83, Wis. Admin. Code. 4. Anytime a failure or malfunction occurs, it shall be reported to the owner of this POWTS. Repair or connection of such failure or malfunction shall comply with Comm 83, Wis. Admin. Code. 5. No one should enter a septic or other treatment tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within these tanks may contain lethal gases and rescue of a person from the interior of the tank may be difficult or impossible. 6. No product for chemical or physical restoration or chemical or physical procedures for POWTS may be used unless approved by the Department of Commerce in accordance with Comm 84, Wis. Admin. Code. 7. In the event that this POWTS or a component of this POWTS fails and cannot be repaired, the following contingency plan is proposed: The failing component shall be replaced. This may require a new soil evaluation to determine where a new soil absorption c component can be. 8. If this POWTS is replaced, or its use is discontinued, it shall be abandoned in accordance with Comm 83.33, Wis. Admin.. Codc. 9. Name and number of local health agency St Croix Couniv Zoning - 715- 386 -4680 10. Name of service contractor in case of failure or malfunction Schmitt & Sons Excavating 715- 549 -6651 il k I r ST CROIX COUNTY SEPTIC "TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 7 - ,v Mailing Address 136r Awfiraket Property Address a 3� `� T RIO .f (Verification requireA from Planning. Department for new construction) City /State c�J1F1Z$'% (i` Parcel Identification Number o32 - /azS o - 1'� 30 3`O e7 LE GAL DESCRIPTION Property Location WV7 : /�, �w '4, Sec. T _�) _ N -R —/A OW Town of llPrse� ry 5 u b 6 1 - eaZy i Y o✓ Est _ - -- -- Certified Survey Map # , Volume , Page # Warranty Deed # �5 ,Volume ,Page # Spec house yes ❑ no Lot lines identifiable yes ❑ no MAINTENANCE \ AINTENANCE 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 syster 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 is less than 1/3 full of sludge. I/wc, 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 he three year expiration date. V".' , -iLff /O S1614A OF APPLICANT DATE OWNER CERTTFICATION I (we) certify that all statements on this form are tnrc to the best of my (our) knowledge. I (we) ant (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. J-d A l / /Q/C/ 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 stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed V OL 1640PAGE f }27 STATE BAR OF WISCONSIN FORM 2 - 1999 Is 45709 WARRANTY DEED KATHLEEN H. WAL_SH Document Number REGISTER Of- DEEDS ST. CROIX CO., WI This Deed, made between Harold J. S chachtner and Margar J. RECEIVED FOR RECORD S chachtner, husband and wife, _ L 05 -16-2001 10:40 AM — WARRANTY DEED Grantor, and Grand Properties, LP, EXEMPT D CERT COPY FEE: --- _ COPY FEE: TRANSFER FEE: 825.00 - RECORDING FEE: 10.00 PAGES: I 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 W 1/2 of S W 1/4 of Section 2 -31 -19 EXCEPT Lots 1, 2, 3 and 4 of Certified Name and Return Add ss Survey Map filed November 6, 1985, in Volume 6, Page 1607, and EXCEPT E1 /2 of NE 1/4 of SW 1/4 of SW 1/4, and EXCEPT El /2 of SE 1/4 of N W 1/4 of S W 1/4 thereof. �•' rtk ou --% VS (-" , W k Jam{ v� P t 032-1005-20- 10 & 032 - 1 -30 -50 _ Parcel Identification Number (PIN) This _i not _ homestead property. - Qk) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of May 2001 ,—. __•_ * Harold J. Scha to IM �tjh AUTHENTICATION ACKNOWLEDGMENT Signature(s) Harold J. Schachtner and Margaret J. Schachtner, STATE OF WISCONSIN ) husband and wife, ) ss. ( _ County ) authenticated this day of May 2001 Personally came before me this day of the above named * Krist -- TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) - instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY -- _ Atto 4 0 Oglan Notary Public, State of Wisconsin Hutisan WI 1 5 5401 16 _ 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 must be typed or printed below their signature. Information Profasaionals company. Fond du Lac. wI WARRANTY DEED STATE BAR OF WISCONSIN 800 - 655.2021 FORM No. 2 - 1999 _ ___ ___ _ �_ S � Z. �� sw LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF SOMERSET COMPUTER NUMBER 032 - 2149 -50 -000 Parcel Number 2.31.19.1301 OWNER NAME: First TODD M Last DICKMAN PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment 2349 CTY RD I SECTION 2 TOWN 31N RANGE 19W %160 SW '/440 NW Line Description Line Description DVIEW ESTATES LOT05 BLK 01 SEC 2 T31N R1 02 LOT 5 GRAND03 04 06 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1- General, F4 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, F8- History, F10 -Exit � NNN 1 �K+ r+I r1N N NrNNN � N N 0 --- ----- It I t o ' 2i '� � Sri so it 5 • a` �af mN x L 7 L N S aa9a �an.a AA '' UN_PLATTED LANDS •3E UNPLATTED LANDS 9aa1 !g_ -- 943.9 THE TA 0 D _a74 ®ERA. LE0_AND DARLENE CBOT 9] �• THE TA - �--� - a,�0 -•,^ 7 x 2370 COUNTY ROAD 1 SOMERSET WI.4025 �^ n �`' _MERSE_T 4 �1 RSET 1 ZONED: AO_RE_ \ \\ ' ZONED: A - _ '$ °° ' °i °g R S '58 "E 52A It D G_RE 4p F� / ...{ *3201, T /N 2 sm xc5r I/ ta9vw - . (rpmn .w � .z I R�° �9316 �/'� \� : 'P�'a , � �A loo 9 % AS I MP9F I - X63 � F �, ,�' 9• N "'�93a x X n n 1 f 0 nf 6� a �°q 976.ex \ -936 h9 >6.9 I 9.0 • %95a5 Nf w � 97 1I o 9" � IOI NI (b o �I� aI X E dY / I I Mf 1 c JlWl rnl wl of , \ dixi a 1 Iw \ a s "M. a e ( e n•w 1z1., O y * I � / � \� \ \� � ♦ sa• a a•,i•w a,oa � H � j Sea • fl4.a �°I' �'' y,,e .b �� �. /a° ao9 ��. � x � � i], w �E LOT 4 CSM 66, P O ,k JASON A._CROTTY x. 95 i����� 4. °'�. 5 � ��O 911.] � , � / / / / ,�° � d •� eaa.a N C h ^I h w *]a•, � �• J� / � as x % �.69�..3 I '1 1 O � all J 6 > INf NI ' w h N i °I wl al � l.� 286 0. 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X O � ~ k c l N. l I © O �i O wl 1 16 I I 61 ZI NI I �)xlta / Y , , IOI N NI S} �- J O I m I ao� Ell R, °15 � 9 :.. .� � /��� -/ / � � � � � �/ J � / � �P ® � — - ss�,zn� ��-S ;�.s/� /��o �� �7 -�?aa� ;/� � �� � County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN In accord with 15.04 St. Croix County Sanitary Ordinance ZONING OFFICE ' Personal information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER rm [Privacy Law. S. 15.04(1)(m)] 1101 Carmichael Road Hudson, WI 54016 -7710 (715)3864680 Fax(715)386 -4686 Attach complete plans for the system on paper not less than 8-1/2 x 11 inches in size. County Sanitary Permit # ❑ Check if revision to previous application 1. Application Information - Please Print all Information Location: Property Owner a e 1/ 1/4, Sec T N, R (or Property Owners Mailing Address Lot Number Block�mber city, tate C_ Zip Code Phone Number Subdivision Name or CSM Number r 1 T pe of Building: (check one) rMity Village mown of 1 or 2 Family Dwelling - No. of Bedrooms: ❑ Public/Commercial (describe use): ❑ State -owned Nearest Road 11. Type of Permit: (Check only one box on line A. Check box on line B if applicable) Parcel Tax umber s) A) 1 Repair 2 Reconnection 3. ❑Non- plumbing ❑Rejuvenation Sanitation Permit Number Date Issued B) ❑ State Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In -ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other . Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. PercoIati n Rate 6. System Elevation 7. Final Grade Required Proposed (Gals. /day /sq.ft.) (Min.finch Elevation Tank Information Capaicty in Gallons Total # of Manufacturer rrefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks A90 IWO ❑ 1 ❑ E: [-- ❑ ❑ ❑ 1 ❑ ❑ ❑ II. Responsibility Statement 1, the undersigned, assume responsibility for repair/ reconnenction /rejuvenationfinstallation of non- plumbing for the POWTS shown on the attached plans. A l icense is not required for terralift repair or the installation of non- plumbing sanitation system. Plumbers Name (print) Plumbers Signature (no stamps): MP /MPRS No. Business Phone Number Plumbers Address (Street, City, State, Zip Code) VIII. County Use Only Disapproved Sanitary Permit Fee Date Issued Issuing Agent Signature (No stamps) ❑ Approved Owner Given Initial Adverse Determination IX. Conditions of Approval /Reasons for Disapproval: ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the ��'�✓ residence located at: Sec. ` _.2 T R_ W, Town of � � St. Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced Did flow back occur from absorption system? Yes No (if no, skip next line. Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concre e Steel Other Manufacturer (if known): Age of Ta k (if known): (Sign ture) (Name Name P ease Print ( (License Number) (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (except for s ection o ening over outlet baff e) Name / Signature MP /MPRS ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer % � /V, e Mailing Address �` I Property Address (Verification required from Planning Department for new construction) City/State Parcel Identification Number /�� - �'Dc� - LEGAL DESCRIPTION Property Location A�L V4, ALL i /4, Sec. -: ,. T-- N -R W, Town of Subdivision �1�,1 �`�� l �s . Lot # _-- Certified Survey Map # , Volume , Page # Warranty Deed # �lf>� �/�� , Volume ,2/ /S , Page # .3 Spec house ❑ yes 0 no Lot lines identifiable yes ❑ no 'STEM 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 is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 .flays of the three year expiration date. alal SIGMA 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 �thc property describe above, by virtue of a warranty deed recorded in Register of Deeds Office. IGN TORE 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 stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed i U 2 115 P 4 3 0 706442 KATHLEEN H. WALSH STATE BAR OF WISCONSIN FORM 2. 1998 REGISTER OF DEEDS ocument Number WARRANTY DJUD ST. CROIX CO., III RECEIVED FOR RECORD This Deed, made between Grand Properties, LP, Grantor, and Todd M. Dickman and Beth L. Tarman, as joint tenants, Grantee. 01/21/2003 08:45AK Grantor, for a valuable consideration, conveys and warrants to Grantee EXERT 0 17 the following described real estate in St. Croix County, State of Wisconsin (The "Property"): REC FEE: 11.00 TRANS FEE: COPY FEE: Lot 5, Grandview Estates, Town of Somerset, St. Croix County, Wisconsin. CERT COPY FEE: PAGES: 1 Recording Area Name and$e&LA r 100 Mill St PO Box 10 Ba�a�m L�ik�, WI 54810 -0010 Parcel Identification Number (PIN) This is not homestead property. This conveyance is given in Satisfaction of that certain Land Contract dated March 27, 2002 and recorded October 2, 2002 in Vol. 1997, page 94 as Document Number 692645; Purchaser's interest was assigned by Assignment of Land Contract dated October - 2002 and recorded J err y A I . 2003 in Vol. _, page ` as Document Number Exceptions to warranties: Subject to all easements, restrictions and covenants of record, and any lien created by act or omission of Grantee. Dated this q " ~ day of October, 2002. Grand Properties, LP BY: �4AJ�Jznc� Mic ael J. Gert in • r AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. S'4-. P ro 1 k County ) authenticated this ! day of , 2002. 9 t.. Personally came before me this day of yc-\e bt f 2002 the above named M tcvucb� (r pr Ma. n r TITLE: MEMBER STATE BAR OF WISCONSIN to me known (If not, to be the person(s) who executed the foregoing instrument and authorized by § 706.06, Wis. Slats.) acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY JOSEPH GREEN Ronald L. Slier NouYPubYC VAN DYK, O'BOYLE & SILER, S.C. sweatwwoonsh Post Office Box 118 Nota Public, Sta e f Louisiana My Commission is permanent. New Richmond, W1 54017 ( ot, state expiration date: m a rc v. 14 , ZOOIn 1 (Signatures may be authenticated or acknowledged. Both are not necessary.) 'Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 3 - 1998 INFORMATION PROFESSIONALS COMPANY FOND Do LAC. WI 800 - 855.2027 ST. CROIX COUNTY WISCONSIN ZONING DEPARTMENT N N N N ■ N N r��.. ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road �... _ Hudson, WI 54016 -7710 Phone: (715)386-4680 Fax (715)386 -4686 To: _...,............ •,r - ..__. From: Fax: Pages: Phone: D ate: E6 I Re: CC: ❑ Urgent . 0or Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle • Comments: E Tr C C o A D l �-� v� &- � P ST. CROIX COUNTY WISCONSIN ZONING OFFICE M N q M ■ — rn�r ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road �•. :.x-- '" ----- Hudson, WI 54016 -7710 (715) 386 -4680 FAX (715) 386 -4686 February 18, 2004 Todd M. Dickman 2349 County Rd. I Somerset, WI 54025 RE: House Re- building project, Lot # 5, Grandview Estates, town of Somerset Dear Mr. Dickman: You have requested the Zoning Office to review your building project for compliance with the state sanitary code (COMM 83). When remodeling or rebuilding a dwelling you are required to examine whether or not the construction involves an increase of wastewater flow. The septic system was installed March 27, 2002 by PMRS (Plumber, Master Restricted Service), Donavin Schmitt #221741. The septic system was inspected by St. Croix County staff and found to be compliant at the time of inspection. The system was sized for a three - bedroom residence. The residence was destroyed by fire in late fall of 2003. You now want to build a new house in the footprint of the destroyed structure. In this case, no part of the septic system is being altered, repaired, replaced, or recomlected, and as such would not require a sanitary permit if the wastewater flow from the structure does not exceed that of a three - bedroom residence. If the new house will have more than three bedrooms, or daily wastewater flow generated will be over 450 gallons per day, then the septic system may be required to be modified to accommodate the increase in wastewater flow; all appropriate permits would then be required. The septic tank was evaluated by Kim O'Connell, PMRS #224263, on February 18, 2004, and was found to be "functioning properly ". As a reminder, to prolong the life of the system, remember to have the septic tank pumped once every three years or when the tank becomes 1/3 full of sludge and scum. Other efforts to prolong the life of the system could be as simple as fixing or replacing plumbing fixtures with water conserving fixtures, reducing shower time, washing dishes when the dish washer is full, avoid using a garbage disposal, using a wash machine with a suds saver feature, etc. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. i � y The project shall comply with all applicable setback standards. Please contact the town of Somerset to obtain a building permit. Should you have any questions, please contact this office. Fly, Grabau Zoning Specialist