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W N wF CD � _. = N v E N = A O� w = b (D En O o o < 'C Rod Eslinger From: Jansky, Leroy [Ijansky @commerce.state.wi.us] Sent: Tuesday, December 11, 2001 6:29 PM To: 'Rod Eslinger' Subject: RE: Permit for the US Fish and Wildlife Service (Maintenance Buil ding ) POWTS installed on federal land is exempt from our rules and permits. If for some reason they wish to follow our rules and obtain a permit that is fine, but we cannot require that level of cooperation. If they do obtain a permit they would need to invite you to do an inspection, and may actually do so to make sure the installer does things as per the plans. • - - - -- Original Message - - - -- • From: Rod Eslinger [ SMTP:Rode @CO.Saint- Croix.WI.US] • Sent: Tuesday, December 11, 20019:49 AM • To: Leroy ] ansky (E -mail) • Subject: Permit for the US Fish and Wildlife Service (Maintenance • Building ) > Leroy: • How do we handle a permit for a POWTS that will be located on federal • lands? It appears that the administrative code exempts the federal • government. > 83.02 (2) Exemptions. (a) A POWTS owned by the federal government and > located on federal lands; • Does the plumber file with any governmental agency for a POWTS located on • federal lands? Should I keep a copy of the permit info. for our records? • If asked, do we conduct an inspection? • Thanks • Rod • Rod Eslinger • Zoning Specialist • Zoning Department • 1101 Carmichael Road • Hudson, WI 54016 • Phone: (715) 386 -4680 • Fax: (715) 386 -4686 > <mai Ito: rode @co.saint- croix.wi.us> 1 Safety and Buildings Division County C 201 W. Washington Ave., P.O. Box 7162 I *i6consin Madison, WI 53707 - 7162 Site Ad'dress De artment of Commerce 222 �� V ' uj /f. Sanitary Permit Application Sanitary Permit Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision 1 m,ay be used for secondary purposes Privacy Law, sl5. 1 m I. Application Information - Please Print All Information State Plan I.D. Number A � Property Owner's Name P t ` �t,1 1 �/ Parcel Number vl�C �30— ioZ9 Property Owner's Mailing Address M ENU roperty Location -76 _q 9. _4 5i .Sff/ 5i: S T.31 N. R 8 B City, State Zip Code PhoR mm . r ; t Number Block Number AW T 'Foy, / bdivision Name CSM Number -�* J V l3 .35 H. Type of Building (check all that apply) t - � __ . �..1 []City ❑ 1 or 2 Family well' Number of Bedrooms t;� ' y 171g - OVillage Public /Commercial -Describe Use 0i )1 e + I►J' Township i5) Y' A i ) ❑ State Owned Nearest Road III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A For County use 1 New 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to nl S stem Tank O Ezis ' S stem B. C1 Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44 B -Pressurized In- Ground 2111 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wedand 22 ❑ Pressurized In -Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. DispersaMeatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals.tDays/Sq.Ft.) (Min.11wh) Elevation 9� NA 9�� 50 7 p VI. Tank Info Capacity Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks �` Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Dosing Chamber VII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature / MP/MPRS Number Business Phone Number AIc rn�soiv TYuow Z -33 Plumber's Address (Street, City, State, Zip Code) 7� g p, �', lea ir- .` t -S ML VIII. Coun t /De artment Use Onl Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Appved ❑ Disapproved Surcharge Fee) ❑ Owner Given Initial Adverse / Af4 Determination IX. Conditions of Approval/Reasons for Disapproval Attach complete plant (to the County only) for the system on Paper not less than 81f2 z 11 Inches In size SBD -6398 (R. 05/01) N _ S�ba.rJ�'af�ie, S {.CroiX la.,c�� M aTiiCc is hce B 3 5ked ■ R� plau,ncnE J1 r C Q P r; Mary S y ftc�, ,4iC4 �. � N,� � ca a�� t sJ�c►ls w�zaba! Cis ptiQL� A s p ka I d ri vc.coay wclls �cs%da, cc o 0 /� exisv�g d�rwe// MPlc 5 r zZoO53 d� yaFy 11.15.2001 THU 03:42 FAX 715 246 4670 ST CROIX WMU 0004/006 r Vol.1484 19 i ACKNOWLEDGMENT STATE OF COUNTY OF SS � � ) On this�k day o , in, the year of 4k, before me personally appeared Dan S. Baillargeon and Jennifer Bail geon, husband and wife, known to me to be the persons who are described in and who executed the within instrument, acknowledged to me that they executed the same. N#y Pe6lic .l S C3NSt V � - County, (SEAL) My commission expires: This instrument was drafted by Louise E. Gerber, United States Fish and Wildlife Service, Bishop Henry Whipple Federal Building, 1 Federal Drive, Fort Snelling, Minnesota 55111 -4056 PAGE 3 OF 3 PAGES 11.15 THC '13:40 Fat 715 246 4670 $T CROIX iV)1D 00 ^'iiA 1484PAr.191 KATHLEEN H. WALSH REGISTER OF DEEDS - -- - _— Document Number Document Talc S.T. CROIX CO., WI RECEIVED FOR RECORD 01 -14 -2000 10:15 AM WAR DEED WARRANTY DEED EXEMPT M CERT COPY FEE: ..! COPY FEE: THIS 1NDENTUR.E, Made this h ? day of- TRANSFER FEE 4665 RECORDING FEE: 14.00 between. DAIN S. BA.ILLARGEON A/K/A DANIEL S. `� PAGES: 3 13AILLARGEON and JEti'IvZFER BAILLARGEON, husband a-rid wife Recording Area of 317 West River Drive, New Richmond, Wisconsin, in the County of Name and Return Address St. Croix and State of Wisconsin, grantors, and the UNITED STATES Lc E. Gerber OF A- VfER.ICA and its assigns, Washington, D.C., grantee, �1.S Fish & Wildliye Se- - EHW Federal. Bldg. i Fed. ter. Ft. Snelling, MN 5511: -4056 WITNESSETH, :hat the grantors, for arid in consideration of the sure of One Million Five Hundred Fifty -five Thousand and 03 5- 1028 --80; 032 - -1034 - 80; 032 Nor100 Dollars (51,555,000.00) to them in hand paid by the - :antee, 33 -20; 032 - 10 33 -30; _..` the receipt whereof is hereby acknowledged, do by these presents _ 032 - 1033 -50 Grant, Bargain, Sell and Conv c , % , unto the grant a:� ; =..s ssi_- S, Parcel ldcrUica:ion NumbCT TDN fIbrever, all that tract or arcel of land 1 gin and bcin in the Towns of 038 1028 - 95; 038 - 1029 -IO; P } g � 038 - 1029 -40; 038- 1029 -60; Somerset and Star Prairie, County of St. Croix and State or Wiscotlsin 038 - 1 02 9 -70; 038 - 1029 -80 described as follows, to -wit: Township Thirty-one (3 1) North Rance NTMneteen (19) West. Town of Somerset. Fourth Principal Meridian: In section twelve (12), the Northeast Quarter Southeast Quarter (NE1 /4SE1 /4), EXCEPT the East 330 feet; the West Half Southeast Quarter (%N /4), EXCEPT Lot 1, Certified Survey Map filed in Volume 2, Page 422, Document Dumber 341820; the West Half Northeast Quarter (W1/2NE1 /4), EXCEPT the West 396 feet. Township Thirty -one 31) North Range Eighteen (18) West. Town of Star Prairie. Fourth Principal Meridian: In section seven (7), the Southwest Quarter (SW1/4); the West Half Northwest Quarter (Wl /2NW1 /4), EXCEPT the following five (5) parcels: 1. The west 210 feet of the north 210 feet; 2. One acre of land described as follows: Commencing at the N - W corner of said section, thence South along the West line of said section for 1435.35 feet to the POINT OF BEGINNING, thence continuing south along said West line for 208.71 feet, thence East at right angles for 208.71 feet, thence North at right angles for 208.71 feet; thence West at right angles for 208.71 feet to the POINT OF BEGINN - ING, as shown on the Certificate of Survey dated November 27 , 1974, filed in Volume 526, Page 368; 3. Lots 1 and 2, Certified Survey Map filed in Volume 6, Page 1611, Document Number 406936; 4. Lot 3, Certified Survey M- ap filed in Volume 6, Page 1791, Document :dumber 423523; 5. Lot 1, Certified Survey Map filed in Volume i 1, Page 2995, Document Number 534323. P PAGE 1 OF 3 PAGES IN 11.15 %2001 THU 03:42 FAX 715 246 4670 ST CROIX WMID 0U5'U06 1 12/16/99 DESCRIPTION DAN S. BAILLARGEON TRACT Township Tp hiM -one (31) North Range Nineteen (19) West. Town of Somerset, Fourth Principal Meridian: In section twelve (12), the Northeast Quarter Southeast Quarter (NEI /4SE1 /4), EXCEPT the East 330 feet; the West Half Southeast Quarter (Wl /2SE1 /4), EXCEPT Lot 1, Certified Survey Map filed in Volume 2, Page 422, Document Number 341820; the West Half Northeast Quarter (W1 /2NE1 /4). EXCEPT the West 396 feet. Township Thirty -one (3 1) Forth. Range Eighteen (18) West, Town of Star Prairie. Fourth Principal Meridian_ In section seven (7), the Southwest Quarter (SW1 /4); the West Half Northwest Quarter (WI /2NW1 /4), EXCEPT the following five (5) parcels: 1. The west 210 feet of the north 210 feet; 2. One acre of land described as follovvs: Conunencino at the NW corner of said section, thence South along the West line of said section for 143 5.3 5 feet to the POINT OF BEGINNING, thence continuing south along said West line for 208.71 feet, thence East at right angles for 208.71 feet, thence North at right angles for 208.71 feet; thence West at right angles for 208.71 feet to the POINT OF BEGINNING, as shown on the Certificate of Survey dated November 27, 1974, filed in Volume 526, Page 368; 3. Lots 1 and 2, Certified Survey Map filed in Volume 6, Page 1611, Document 'Number 406936; 4. Lot 3, Certified Survey Map filed in Volume 6, Page 1791, Document Number 423523; 5. Lot 1, Certified Survey Map filed in Volume 11, Page 2995, Document Number 534323 :i GLK 12116/917) 11/15/2001 THU 01:41 FAX 715 246 4670 ST CROIX «'MD Q003.'006 1484P 192 The above - described lands are acquired for administration by the Secretary of the Interior through the United States Fish and Wildlife Service, under the authority of the Migratory Bird Hunting and Conservation Stamp Act of March 16, 1934 (16 U.S.C. 718- 718h), as amended. TO HAVE AND TO HOLD THE SAME, together with all the hereditaments and appurtenances thereunto belonging or in anywise appertaining, to the grantee and its assigns, FOREVER. And the said grantors, for themselves, their heirs, executors and administrators, do covenant with the grantee and its assigns, that they are well seised in fee of the lands and premises aforesaid and have good right to sell and convey the same in manner and form aforesaid, and that the same are free from all encumbrances whatsoever, SUBJECT, however, to a Right of Way Easement to Polk- Burnett Electric Cooperative dated June 26, 1941, recorded September 6, 1946 in Volume 263, Page 440. (Parcel I); to a Right of Way Easement for Rural Electnc Line to Dairyland Power Cooperative dated October 29, 1953, recorded may 19, 1959 in Volume 358, Page 34, Document No. 258002. (Parcel I); to a Right o Way Easement for Rural Electric Line to Polk - Burnett Electric Cooperative dated September 17, 1953, recorded March 6, 1959 in Vol. 355, Page 529, Doc. No 257142. (Parcel 11); to a Conveyance of Lands to County for Highway Purposes to St. Croix County dated April 23, 1975, recorded May 2, 1975 in Volume 522, Pale 550, Document No. 326774. (Parcel 11); to the rights of the United States and third persons, if any, as provided by the Patent of record. And the above bargained and granted lands and premises in the quiet and peaceable possession of the grantee and its assigns against all persons lawfully claiming or to claim the whole or any part thereof, the grantors will WARRANT AIVD DEFEND. WITNESS WHEREOF, the grantors hereunto set their hands the day and year first above written. EXECUTED AT thiv k day o � AJ4 .. L.S. Dan S. Baillargeon ' *fer ' B&argeon ' PAGE 2 OF 3 PAGES e I I � Z � p 17 m + y p N 1 < p GSM K - il T ' r N 1 1 1 Ln I � Q { i n co j N I > I n Z I � I I� I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 4 Mailing Address 7,/ A) Property Address Z - c 0 0 (Verification required from Planning Department for new construction) City /State AlP_u2 k' k n Parcel Identification Number 039-1,02q-60-10,9 LEGAL DESCRIPTION Property Location Nbv ' /,, SW ' / <, Sec. T N -R_,g W, Town of Star Rea „ri e-, . Subdivision N X Lot # Certified Survey Map # , Volume /-3 _, Page # -359 Warranty Deed # _ go , Volume . Page # Spec house ❑ yes no Lot lines identifiable [Er 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, journeymanplumber, 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. 10/31/ GI S ATURE OF APPLICANT F W 5 39 oq (o O Ta lc e I- DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the p perry described above, by virtu of a warranty deed recorded in Register of Deeds Office. ATURE OF APPLICANT F WS �l eq G O ' c cr DATE 3 * * * * ** 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 1450 Wisconsin Department of Comnwoe SOIL EVALUATION REPORT pap 1 of 4 Division of Safety and Buildings in accordance with Comm 85 Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site an on not less than 8% x 11 inches in size. Plan must County P PI paper St. Crooc include, but not limited to: vertical and horizaital re M), dKection and percent slope, scale or dimensions, north ce to nearest road. Parcel I.D. �' �" 038- 1029 -60 -100, IN 7.31.18.136A Please print Lyon. Reviewed By Date Personal information you provide may second -IWY Law, s. b•04 (1) (m)). Property Owner Pfbperty Location U.S. Fish & Wildlife Service [f V—jity NW 1/4 SW 1/4 S 7 T 31 N R 1 8 W Property Ownes Mailing Address 2 # s. Name or 1764 95th Street4x CSM Vol. 3, PG. 3594 City Stye Village Town Nearest Road New Richmond WI 715 -2 - 4�' Prairie 80Th Street 1' New Constriction Use: I Residentia ' rooms Code derived design flow rate 20 GPD Replacernent 16 Public or commercial - Describe: Maintenance building w/ 1 employee Parent material Glacial outwash _ Flood plain elevation, if applicable na General commerds and recommendations: Install 1 trench at 3' x 31.25' using 5 High capacity BioDiffuser infiltrator chambers at 95.50'. E Boring # ._.1 Boring je Pit Ground Surface elm 99.50 ft. Depth to limiting factor >88" in. Sal Apron Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD11t ffiff Eff#1 1 0 -10 10yr3/2 none Is 1 msbk mvfr gs 2f 0.7 1.2 2 10 -21 10yr3 /4 none Is 1 msb mvfr gs 1 fm 0.7 1.2 3 21 -38 10yr4/4 none Is 1 msbk mvfr cs 1 fmc 0.7 1.2 4 38 -50 7.5yr4/6 none s 0 sg ml cs - 0.7 1.2 5 50-88 10yr5 /4 none s 0 sg ml - - 0.7 1.2 ❑ Boring # — j Boring 11101 Pit Ground Surface elev. 100.02 R Depth to limiting factor >93" in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots G /Itz *Eff#1 ff#2 1 0 - 10yr3/2 none Is 1 msbk m vfr gs 2f 0.7 1.2 2 8 -19 10yr3 /4 none Is lmsbk mvfr gs 2fm,1c 0.7 1.2 3 19 -36 10yr5/4 none Is 0 sg dl cs 1f,2mc 0.7 1.2 4 36 -50 7.5yr4/6 none s 0 sg dl cs ifm 0.7 1.2 5 50 -93 10yr5/4 none s 0 sg dl - - 0.7 1.2 * EffIuen t #1= BOD ? 30 < 22D mg/L and TSS > <150 mglL * = BOD < 30 mg/L and TSS <,30 mg/L CST Name (Please Print) Sign CST Number James K. Thompson 3602 Address A.C.E. Sal & Site Evaluations Dot Evaluation CanduCted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 8/8/01 715- 248 -7767 p owner U.S. Fish & WOMe Service - Paroel lD # 038 1029 -60 -100, ID# Page 2 of 4 F # 3 ] Boring Boring Pit Ground Surface elev. 98.95 ft. Depth to lirniting factor >87" in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 2 *Eff#1 *Etf#2 1 0 - 16 10yf3/2 none Is 1 msb mvfr gs Tle-0. 1.2 2 16 -33 10yr3/4 none Is 1msbk mvfr g 1.2 3 33 -54 10yr4/6 none is 1msbk ds cs 1.2 4 54 -70 7.5yr4/6 none s 0 sg dl cs if 0.7 1.2 5 70-87 10yr5/4 no s 0 s g dl - - 0.7 1.2 F—I goring # I Boring Pit Ground Surface also. ft. Depth to limiting factor in. Soil Apps Rate Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots *Eff#1 tf l2 ❑ Bori ng # _f P Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDMV *Eff#1 *Eff#2 * Effluent #1 = ODD ? 30 < 220 mg& and TSS ?30 < 150 mg/L * Effluent #2 = SOD <30 mg/L and TSS < �D mgIL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an ahenm to format. please contact the deverhment at 608-266-3151 or TTY 608-264-8777. • SOIL AND SITE EVALUATION PROPI?t1Y OWNER U.S. Fish & WHO* Service 1450 page 3 Of 4 PARCEL. LDJ 038 - 1029-60-100. IDN 7.31.18.136A A.C.E. Soil 8t Site Evaluations REPORT MEMO Sizing calculations: 1 full time employees: 13 gnd. Estimated daily wastewater flow: j 3 gR x 1 sn% =19 5 gallons ner day Design atewater Flow The waste generated from this facility may be "high strength" as defined by Comm. 83.44(2)(a) Wisc. Admin. Code due to the lack of dilution of the black water entering the system. It is recommended that system sizing be increased to allow for breakdown of the waste. • Qe� .' l c(SO ■ So;/ C ✓a 1ua - 6 o k.s. F���� cJila//iA 44v5c,; Sec, 7, T, o 5 Aliric, S� . �roiX �'.,� ✓1 C A 5Ii-J 5,d.�rC), M a;hc"Ia nc-c S 3 5 k,e.d ■ (liplau.noli- S yy st�n, 1;•�es��c ArIQ pr ;mart' S !4 /C4� © ■ 4sp►�alE A s p ko d rive Loay cx,s�;,� w�.11s re5idtrt p O e Shin oar WC // xj d r pa.y�y