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HomeMy WebLinkAbout038-1125-70-000 i COMMERCIAL TESTING LABORATORY, INC. `514 Own Street, P.O. Box 526 Colfax, Wisconsin 54730 715 -962 -3121 800 - 962 - 5227 ST. CROIX ZONING REPORT NO*** 17497/01 PAGE 1 ST. CROIX CMTY REPORT DATE. 1/31/92 COURTHOUSE DATE RECEIVED: 1/30/92 HUDSON! WI 54016 ATTN; THOMAS Co NELSON I �tER; David 6 Donna Kobs LOCATIONS 1885 Cty Rd, C, Somerset COLLECTORS M. ,Jenkins DATE COLLECTED; 1 -29 -92 TIME COLLECTED; 2;OOps SOURCE OF SAMPLE; Outside faucet DATE ANALYZEDS1- 30-•92 TIME ANALYZED COLIFORMS 0 /100 ml INTERPRETATIONS Bacterioi.ogicalty. SAFE NITRATE -NS < 1 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Califore Bacteria /100 ml. , Nitrate - Nitrogen, mg/L 12 O � RE�EwE4 A- ra 31 a�92 LAB TECHNICIANS Pam Gane F SS cRDlx c w ;' !P!N `^QU �.FIGE WI Approved Lab N 19 Z 0tA01G f ` { Means "LESS THAN" Detectable Level Approved by'. 9 5 �m ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 t ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse (°c 911 4th Street / Vk �� Hudson, WI 54016 ` Telephone - (715)386 -4680 The t. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion of this form is essential so that the property can be located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING - - - - -- -FEE: $ 25.00 xxx (For nitrates and coliform bacteria) WATER TESTING FEE: $127.00 (For VOC'S) SEPTIC SYSTEM INSPECTION - - - - -- -FEE: $25.00 xxx (Determines if system is properly functioning at time of inspection) Property owner's name David A. and Donna J. Kobs Property owner's address 1885 county Road C. Somerset, WI 54025 Legal Description NW 1/4 of the NE 1/4 of Section 31 , T __L_ N -R 18 Town of Star Pr a, r;e Lot Number Subdivision Name FIRE NUMBER 1885 LOCK BOX NUMBER y 3 �� ��-�� -7 G Color of house ' Realty sign by house? If so, list firm. _ PLEASE CALL DMA KOBE FOR AN APPOINTKW - WORK TELE UME # 1612) 439 -."' I PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting services Bank of Somerset Telephone Number (715) 247 -3348 REPORT TO BE SENT TO: Bank of Somerset, ATTN: Kristen Di P.O. Box 22 S WI _ 54025 Closing date ASAP Signature M77) ST. CROIX COUNTY WISCONSIN A " fit ZONING OFFICE J ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386 -4680 Jan. 30, 1992 Kristen Dixon Bank of Somerset P.O. Box 220 Somerset, WI 54025 Dear Ms. Dixon: An inspection of the septic system on the property of David & Donna Kobs, located at 1885 Co. Rd. C, Somerset, WI was conducted on Jan. 29, 1992. At the same time a water sample was obtained for testing. The results of that test will be sent to you as soon as we receive them back from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Sin rely, Mar enkins Assistant Zoning Administrator cj Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) state Plan ID No. 48 0 / 8198 Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. /U Permit Holder's Name: City Village X Township Parcel Tax No: Kobs, Dave Star Prairie, Town of 038 - 1.125 -70 -000 CST BM Elev: Insp. BM Elev:, I BM Description: Section/Town /Range /Map No: M.0 o� Ma CAW3 31.31.18.516E TANK I FORMATION ELEVATION DATA TYPE AN ` NUKE CAPACITY STATION n �S HI FS ELEV. Septic ��l-- B nchmark tSdD c.A k*- Dosing Alt. BM eration Bldg. Sewer r o 7n g - St/ Ht Inlet TANK SETBACK INFORMATION S t /Ht Outlet ' �•S �S W , v ent to Air in ROAD T5Mn e S ept ic f r Ut Bottom 39+ q H eader/Man. 75 Z � '+ ion -S• L f H olding Irot. Systern •a •D ' p F inal ra e - \ PUMP /SIPHON INFORMATION /) anu ac ur r _, PM yip model q um e 5 l t►a-c ,./�tN- �• �� 1 -7 3 f 1 Uri IL ITt Ion LOSS system meaci N � �� thw'� �• Q � , � f v orcema i g I. 501 B5 RPTION SYSTEM DI 3 ' �, INFORMATION CHAMBER OR UNIT uw Pipe(s) Leng Dia Le th pact x Pressure Systems Only xx Mound Or At -Grade Systems Only Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes _'� No , � , COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: M & — } /Za pection #2: Location: 1885 Cty Rd C Somerset, Wi 54025 (NW 114 NE 1/4 31 T31N R18W) NA Lot e — rcel o: 31.31.18,616E 1.) Alt BM Description 2. Bldg sewer length - amount of cover = - _ JZ �t�✓ 3 — L�°�'r�'� f°wv re c e«,c�P - Plan revision Required? [No Use other side for additions inform ag to — tnsepctoes Signatare SBD -6710 (R.3/97) S` a ig+ Safety and Buildings Division County W r 201 W. Washington Ave., P.O. Box 7162 �T �seonsin Madison, WI 53707 — 7162 Sanitary Per n N� mb (to be fill in by Co.) Department of Commerce (608) 266 -3151 O �i1��( C� Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s15.04(1)(m) Project Address (if different than mailing address) L Application Information - Please Print All Information Property Owner's Name Parcel # Lot # Block # F3 U9 ro s 6�� - / ^ 6D o Pr / operty Owner's Mailing Address Property Location o� ' /., �e, ., Section _ 5 City, ' S � ta n te � / ,� } / Zip Code Phone Number 6vr IC vv / 540 � �5 7 �t3Q circle o ) II. Type of Building (check all that apply) T N; RCLE org ❑I or 2 Family Dwelling -Number of Bedrooms Subdivision Name CSM Number ❑ Public/Commercial - Describe Use V El State Owned - Describe Use ❑City_ ❑Village Vown ,r� ship of P 2 tv Ill. Type of Permit: (Check 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 t Previous Permit Number and Date Issued Before Expiration Plumber Owner G�(j�q{j��. MAY 2S - 2,n / IV. Type of POWTS System: Check all that appl g 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 Weaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ther (e lain) V. Dispersal/Treatment Area Information: 1 *1 1 Design Flow (gpd) Design Soil A Rate(gpdsf) Dispersal Area Required (sf) Dispe Area P posed (so System Elevation - ISO I r J 1 70 0 G (31G Ct 173-S VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement I , the undersigned, assume responsibility for installaganAC the POWTS shown on the attached plans. Plumber's Name (Print) Plumbe MP PR tuber Business Phone Number r 3a 1 - 715- -76s , 21 61 P n s Address (Street, City, State, Zip Co e) x 66 S p_c__w UJ S 4 o Vill. County/ e artment Use Onl Approved tsap Sanitary Permit a (inclu s Groundwater Date Issued lssui g Agent Sign ni (No Stamps) Surcharge Fee' Own n Reaso � 30 ❑ n for Dem IX. Conditions of � t3lM S,cK�(A,� SYSTEM OWNER: `" �'" 1 Septic tank, effluent filter and 3 S @ r� Q.r+t(¢ Qkrtn& t dispersal cell must all be serviced / maintained a / as per management plan provided by plumber. Z, �e� 2. All setback requirements must be maintained `_ /� as per applicable Codelordinances. S t Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size s yg� d::V SBD -6398 (R. 01/03) t ���� Q - fin / �+Q. • Build' gs Di tY � ��� An I W hin A e., P.O. Box 7162 Visconsin edi WI 07 AKY 2 4 2 itary tail Number (to be filled in by Co.) 6 3 51 �VI b l9 De artment of Commerce Sanitary Permit Applica Y ST. CROIX COU ;Mate PI LB. Number �� In accord with Comm 83.21, Wis. Adm. Code, personal information may be used for secondary purposes Privacy Law, sl5.04(1 Xm) ldress (if different than mailing address) Sa r.t, L Application Information — Please Priat All Information Property Owner's Name / Parcel # •J # Block # �)KpE r ow t ZS- 70 -0000 Property Owner's Mailing Address Property Location City S tate �� Q, Zip Code Phone Number �-- Section c� rcle Vv' 5404 .15302— TN, REo ` 5 110 II. Type of Building (check all that apply) e , a _ �.1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Number ❑ Public/Commercial - Describe Use ❑ state owned - Describe use Z D ",54-- CJG /Z G e ,C5 ❑City_❑Viilage WI'ownship o f !i4AR. III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System 9 4miacement System ❑ TreatmmvHokling Tank Replacement Only ❑ Other Modification to Existing System B. C1 Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type ofPOWTS Syste Cluck all that a pply) g Non - Pressu rized 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 Sarul Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Li el -less Pipe ❑ Otber (explain) V. Dis isn"reatmeat Area Information: Design Flow (go) Design Soil Application Rate(Wdsf) Dispersal Area uuW (s rspersal Area Proposed (sf) System El � on �d ✓ . S ✓ ✓ 60o ✓ 3. VL Tank Info Capacity in Total Number Manufacturer Prefab Site Steel I Fiber Plastic Gallons Gallons of Units / Concrete Constructed Glass New Existing Tanks Tanks Septic or HoWing Tank J Aerobic Tnestment Unit > VII. Responsibility Statement - L the audersigned, assame responsibility for i the POWTS shown on the attached pbm& Plumber's Name (Print) Plumber's S' RS mber Business Phone Number CFF Fi 2Z3'Z42- 715- 7 s6S 24 61 Plumber's Address (Street, City, State, Zip C ) F0, 8 z 5 DKCsse r 540 tme ono nt Use On ly ppr oun tme ro Sanitary Permit Fee (includes Groundwater lssu r _ Issuin ent Si Surcharge Fee) ❑ en Reason Denial VL Conditions of ApprovallReasons for Disapproval snterl� cwvu: 3) 1. ftpee tank, *Mtiertt inter and depersal cell must all ba seryltes / ma kftk'dd � n vet nw agament plat, provided by dbsclt p � 5 � i a� r C� cam. ►r`^,.' IOW - I AN s � roust be mebtalml : ss per spple" code I ortgnh xm. Attack complete plans (to dw county only) for toe system on pnpet• not less thas stn x 11 inches is sin y va s�C �a� �� � 10c SBD -6398 (R. 01/03) w 4, 9,— A)p -1 1 , 5 =;t tti•7 ;N y� ..pNl 3DC b��E Koas ' ,i ► M/ !8� S Cry J!W V 4 NE 'A S S [ T 3 n1 �2 I . 20 C So C(ZSEY' W/ 72 g46Z5 /z �s h? ,3Xt Z 1 4 VkrMl eAP ® BEt�A,6�lA(11(Z MAIL Flu ;)2EC EL: 101,11 Cl S OIL ��?,1JL.�S E x tSTWU s Prue - rAk)rc LTA 1rUSt'B? Late srzE .C�O mi'Uflr�E El 1IEW WECLC 2 L l TM AJ K FiLrE iZ a&LE I ' ib i �I i o�u�E Koa� 18 � CTy lip 0 S 3 [ T 91 n1 f�2 � 8 ti/ So ErZSit' W/ �T �� t �R�� - r ©�✓�ss� P 54625 V' 98,7 9� z 1 8X1 Z 1 � GaQP69 ✓EW7 eAP EL = jo0 ® Bcwdkj 2 "IL ti SPEC EL: 101,11 ❑ SOIL one WLs F- )(M) SSEPT)O- TA ft iEg Jus>' ,D7 Ore s lzE 4-, (?,oml'La flrrr Et A'EW WEEtK TAW( Pz9 te F/L7 - E IZ a&LE- 1 jb i Wisoon of Commerce SOIL EVALUATION REPORT Page -1—of—a Division of Safety and Buildings p C /+ C ��Il in accordance with omm i3,�AliSt Rd !� ounty S4 Q ` Attach complete site plan on paper not less than 8 112 x t i ii ches in size. Plan must include, but not limited to: vertical and horizontal reference p iint (BWe*rgen�oa6 larcel I.D. percent slope, scale or dimensions, north arrow, and locatio and d stance to nearest road. ® $ S —70 - 0 Please print all informatiorf ST. CROIX COUNTY evie d by Date C Personal information you provide may be used for secondary purpos s (Privacy Law, s. 15.04 1 m . 5 2 fi Property Owner Property Location Govt. Lot W W 1/4 t$_1/4 S ) T (i N R E (,r g Prop r Owgg Mailing Address Lot # Block # Subd. Name or CSM# City Stati Zip Code Phone Number ❑ City ❑ Village Town Nearest Road ttrllu ��5�"i"' C0.5 I c 53b a. a � Ire c_ C- 0 New Construction Use.% Residential /Number of bedrooms _ Code derived design flow rate DD _— GPD r eplacement ❑ Public or commercial - Describe: Parent material i yt SA2Ar,<1L-\ Flood Plain e!evation if applicable _ tt General comments 5 V J � e �- j t� - s l.,a,•-''} . S F o r �'t�•: 5 �f` �� f� and recommendations: ---- -- 1- l I K ►rV. Boring Boring # 7 �� Q ft. Depth to limiting factor 0 In. Pit Ground surface elev. � — Boil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF In. Munsell Clu. Sz. Cont. Color Gr, Sz. Sh. 'Eff#1 'Eff#2 -1b 3 f 5 L � C< Q W ern F5 M J' C l r^ !L_3 9 - 51) - -51 O F 5 vL yn \F ir .j i . ,bA ®Boring # Boring pit Ground surface elev. — 7 ( 3 - 7 f. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft= in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 -�� 0403 5Ls �� y fte - 7 .5yR S(.- . S w I r^ S 3 )6 ,36 7.51P Y /10 F LX t J t- i l I r t7 Fe _ 7SY sj - TSb V_ jhv Fr , 1D Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD 5 30 mg/L and TSS 5 30 mg/L CST Name (Please n Signature CST Number l t d�ss� ••� ate valuation Conducted Telephone Number r .,. Property Owner boy ei A . R U V s Parcel ID # Page—Z2 of F Pit Ground surface elev. Boring # ❑ Boring /7 a* _ ft. Depth to limiting factor 95 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 tSyR 1=5 55k- M 'jFr 1 0 ❑ Boring �3 !� D • 0 Boring # H� __ E] 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 a 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/fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. '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 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- 9730(0..6/00) I Property Owner bay ei K a b �,' Parcel ID # Page of Boring # Boring p Pit Ground surface elev. _ 97. aDft, Depth to limiting factor 95 _ 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 I 'Eff#2 Vf r I O Aloe a Boring # ❑ Boring ❑ pit Ground surface elev. � f _ 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 F-1 Boring # Boring G ❑ ❑ pit round 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 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 need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. sao4330 trtsroot i �o L G • NibV V N IE .9-c. 3 1' 'r B , t "= ' 1 GtGr G S "t" o;. �k 1 Y to pgrGet oho No , l 0"1' r �• �K dr � o�.,�a GaraS I � d I j OD :aU a am �$.07 0 17, a- _ _ I, .:. w, �� �_ __ �, __ __ _. __ __ ,, _ __ __ - _ _ _ �_ ___ _ , __ � :_:_ _ .. __ -^ �� , _ _ : _. _. � r', � __ i - - -- j r _. __. - - _ _ _� _. _ _ _ -Q, - i i - _ - _ _ I _. r + -- __ _ __- _.__ - ,_._.. - - - - -- _ _ __ _ __ _ - _- - - -. _... _ i i ._ _ . __ I -- _ _ __ -- - - - - ,. I __ _.. -- ._. _ � - __, - _J__ - -- i � � i _ _ _ _ __ __ ' . -.�_ __ '- -- -- ' I - __ _ i __ _ ___ . � - -- _. _. i i __ - -- , �, - -- -- ___ _ _ ; 1 __ i � � � � � -I I - - - __ _ '. � -- -- -- - � i __ _ _ __ _�. ... _ _.. - ' _ - 'r - � � -- - - - _� .. -- � i � � � I i � i - _ ___.._ i j j �. I __ -.._ _._ . � +._,__- _ _ i I- _t AnD CvvStATION Pag pdor' o use a ' the PMM unkW far the p menm of 1'XWede -the veannem process- aACilar•da &iPenr or 0thW- 9 ' O° - ff bigh are - removed- by a -saptsge servic.�iiV. opma0or.prim -to use. detected have the- SYstam start up step not *=w when.swl corutit are ft men ar the infiiaarive surface_ ' Otai 0 utft9es , 4xJMp tanks may is rested fff abmm 4o� leii#ewater ieveFs; 1Nhac power the excess � WM be disdurved to the + speisai r (s}.ia area dose, ovwba&V the cefts) and aW'resuit in - the � TO avoid: this =Ula�bon have the of the pump eep or p tank removed by a Septaga • of surface power to the effkrent PumR Or a P or M%rM to assess in Opp poor to resr� res re noe3reai• WIvels within the puns ,area` c Y- ° - the- pm to 00 -n0t drive or park-vehimles cver Unks and d- calls. Do nat drive or v Adlin 15 f8et.down scope of any mound or at grade soil aroa. Fmk °�' °f ati>avvrsetf b or cOmPaM the am Pledm aion or efimim ion of - the fallowing *am the W sGroatn may impoove the P� and ` y} be�, �edOMS coma swab de 5; derma flOSS' I� ap,, fat - . the �f2 of the �_'�Rf Yu'_ wYGS- - b°°v��.I .T_ --+•+{ �- 6*M r = Cn f7lsei'y = tampons, and watm Softener Mne. -- -��"• ��... AUNDOliUM ENT VflleeYe the POWTS failr WWOr is PeCamnentiy taken out of service the - fodavving steps sha8 be tmksn TO ststme that the system is * -and rely atrar►doned in . conVftwe y ft ch aPter Comm 83.33, Wisconsin Adenaeesn'adve Code: ' 00V to tanks and pits shad be d9cmumated and the abandoned pipe openRegs • The contents of.ae-taeieks and puts shad be rerreoved,acxl Pfy dtsp,osed of by a Septage Servicing Operator. • After P=png, al tanks and .pits shad be excavated and removed Or their d6vers removed and the void Sol gravel. or XWW-t said 7rwmwial �� lNed with CONTMENCY PLAN if. #W -PoWTS taus and carmot. be rgmked the lbloviing en measures have be. or.nx= be � - taken4 m provide a code MN A T_ has been and may be ut� for the bcatiOn Of a � sal a absorpdon should be protcted from drsturbwme, and comgmabon and shorrid -no t wed from . and- proposed sa mauve, lot -in" and weds_ Faicae to piatect the area by result in the need -for a new soa and site evArfflitln In eswbrm a scertabie repWcenW"f - �5' with the ruies in effect at that farce- a n =t By... must A lachn " rem area is not avadabie-due w setback and/or sad motions. Barring advances. in POWTS gY a holding tarok nray be, wed as a last resat to replace the faded POWTS_ 0 . The - site has not been. evakwted- to adeniify a stftmWe �t area. Upon faaue of Ehe POWTS a sob and site evaivawn must be perfganed W locate a suitaWrePbcanlenr area. if no repWcernant area is avalabie a hoWkV tank May be kmtaged as a• last. resort To rem the faced POWTS_ Q Mound and at-grade sGff absMVdW SYBts may be reowtstnicted in place inNow'seg removal of the Womrat at the adktrative warfare_ Hecxnsbt is of such systems must cag wide be rules in effect at that time_ < <WAt > > - SBrW PUMP AND OTHER TREATjgENT TANKS MAY CONTAW LET• M GASSES ANDJC)FI - WSL OXY6`Ell_ DO NOT BITER A S13 PUMP OR OTHER TREATIOW TANK UNDER ANY C*tC N SfANt�S_ .DEATH MAY RESULT. RES�iIE OF A P8t,SON FROM THE INTERIOR OF A TANK MAY'gE 1LT OR M4pOSS�,E„ ADOCMNAL P+D1Af;51 lSTALLER POINTS NUMITAINER Name Narne Phor� r5 . _, j SH'TAGE SBMMG OPERATUR (PUMPER) Local STORY AtrryoR Mame - Phalle - l ONOW Cvuo/ -phone : - 7( 5 -38 ( A cob 0 Thin doa:nem was drafted in 00mPb9 oe with chaffer Comm 8 3- 22i21tbH1HdWdfl - 8. POWTS OWNER'S AMUAL &MAMMEWPL . ' of FEE- TXM 6 t3.S S nark capacity • Peaaat ir kA Sew Tan k UWxdarawer V"�N� ►NA PAPJUAEtHf.S Effluent Filter Mamdachner � NA of a a dA Effluent Filter Modal � T /0 -� NA of -Pubk FaoW -hints I&NA Pump Tm* Copse" NA flaw• (average)• 0 7 P rrnp Tank Manndacttxer NA D 6 flow (peaW, Ms*nabed x 1.5) `� �(j Pump R nufactiner _kNA ScR Application RAM i +� /{ Pump Mode! NtA d hif(uentlE�tieort Quality sverage' Pretrieatrrrent l.)rnit NA Fats, ON & Grease - (l G) S30 mglL Q Santifficavel Filter d Peat F*w ffioChenacai Oxygen Dernand WOW SZZO mg& p NA © Mechanicat -Aarad w 0 wet)and Tonal SuspWded Senfids n 51S0 siig& D Dsirdf cnnn l7 Pretreated Effluent (uiW. - _ MoatthlY average Di#wwsal Cell(s) •O NA Kocd� Oxygen Dernand (SODJ S30 n(g/L Ar1n-Ground (gr4vitp) a kkamind wed) Ttmd Suspended SpN s P35Sf 530 molt- - �NA 43 Ar- Grade. 17 Mound FootCo6foan (gem n ineaa) S1 Cr clullOOm( Ds -(:floe D Othd: hlaidrnu n Effluent Particle Sze Ys in dia. E3 NA Other' O NA Other O NA Other 13 NAB "Vakres Typieal for domeseie wasumater anti Septic tank of twnt. Other © -WA UA(NTENANCE SCHEDlliE. Se 'Vice &eW - Irmpect =vditiori_af tank(s) At lean -mm every: © mandrils) ( 3 ). yeos) CI.NA Pnuinp out contents of'tank(s) Wen and scum equals one4hirtl 09 of tank volume ❑ NA bapect ea11(s} At'least ounce estrery: 3 0 y ) Pdaxknmn 3 yi=W 17 NA Clean effluent ifter - At least once every: Q memihlsl ❑ NA Inspect Purn pump cords &alarm At feast once every_ 0 Kq Flush tat erals -and pies ira test At bust once every* Jiq NA Odeer: At least once suety: fl y earW Other. - ❑ NA NAWTeUNCE Inapections of tanks and dtspwz[ Drips zW be- made by an individual carrying one of the fglf% wing li ansas or Master Master Kirnber Pastricted Sewer. POWTS Inspamor, POINTS Mauartai< Septage Servicing Operation- Tank IFISPOMICUS must include a- vnseal inspection of the tanks) m ideat:ity any mmsing or Wukea hardware, identify any crack& or IsisIcs. measure the vokwm of corribined sludge And sc urn and to check for any back up w po>ditg of effluent an the ground surface. The dispersal caU(s) sill be visually inspected to check the effluent levels in-the t>lservadoWpilm and to dm ck fox any potdgng of effluent on the around 'surface. The ponefing of effluent on the gratatd antace mey indicate a faAV condition and rem the klWledlWi r0dfk2dM of the k>t. tegUbMDry Wth0ft. When the combined occunudation of -sledge and -scur n in -any tank equals; one-third (Y or more of tine tank volume, the enfiF corntems of the tank shaft be retitoved by a Septage Sere -roll Operator and armed of - in accordance vAth chapter *NR 113. Vlliscat m Atiwasoaitive Code- AD oiler services, unchxling but not &tamed to the servicing -of effluent filter . medunical or pressurized components, pretreaftnerit units. and any servicuig at intervals - of eI27mondm -small be performed by a cwtified POWTS MaitwO nw i A service .report shell. be provided-mo the Jocai rely authority within 10 days ort cornpledori of any swvice event vs•aas•a.V rave• aa.VV atza ,era VVV VVVV ST. CROIX COUNTY ` SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer �K1�E K O Mailing Address CT`I RD � WI .�4bZ5 Property Address AS A &v]z (Verification required &o»n Planning & Zoning Department flu new construction.) City/State Dr(ctz, w/ Parcel Identification Number b3�3' II25 76 ° 0602) LEG [�, . DESCItIFTLO–N Property Location 'A , IJE i/ , Sec. , T N R 18 W, Town of :S - TAE- - F�e -A P. I C– Subdivision , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # , Volume , Page # — Spec house ❑ yes Ll no 1.ot lines identifiable l) yes O no STEM MAINTENANCE AND OWNER CERIMCATION Improper use and maintenance of your septic system could resuk in its premature failure to Handle wastes. Proper mainttnamec consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper: What you put into the systaat can affect the function of the septic tank as a treatment stago in the waste disposal system owner maiatctiance responsribilities are specified in §Comm. 53.52(1) and in Chapter 12 - St. Croix county Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & zoning Department a certification form, tsignud by the owner and by a master pinmbcr, journeyman plu nbcr, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) alter inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 1 /we, the undersigned have read the above regitiremmts and agree to maintain the private sewage disposal system with the xiandards sat forth, herein, ax :set by the Depammmt of Commerce and the Department ofNatural Resources, Statc of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Depattmertt within 30 days of the three year expiration date. i/we certify that all staternertts on this form an true to the best of my /our knowledge. I/we am/am the Own=($) of the property described above, by vim of a warranty deed recorded m Registrar of Deeds Offnca. Number of bedrooms SIGNATUR F APPLICAN(S) DATE s• +pay information that is misreprmated may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if rcferme is made in the wwraoty deed. (REV. QW05) DOCUMENT NO. STATE BAR OF WISCONSIN FORM 3—IM T HIO 4VAC6 Rs"*VtD FOR RIC01110111416 DATA QUIT CLAIM DEED L 9 42`1044 779PA4E 040 kEOSTERS OFHCE ST. CRW co, Wis. .......................... Jk_ ................................... ............................................ Reed. fOr Moo fibs 27th ....... .................................................................................................. ..... of 1947 it- slalm to.. .... .... yid A. 9:30 ................... ............ PXqL_.g ........................................ ............... ............. .............. . .•- • ........ ............................... .. . .... .. ..... ........ ... . .•. .......... -• ..... th following de scrib ed real estate .. In . St., . .-Cr.Qi Cou.nty, T State of Wisconsin: FMTW*" TO Michael E. Sias Part of NW% of NEh of Section 31-31-18 PO Box 69 described as follows: Commencing on Ely New Richmond WX 54017•0069 line of County Trunk Highway "C* 665.1 feet N and 240.1 feet E of SW corner of said Nwh Tax Pared No: .............................. of NEh; thence E parallel with S line of said NWk of NEh 167.1 feet; thence N0 100.0 feet; thence N parallel with said S line 133.7 feet to said Ely line of County Trunk Highway "C"; thence Sly on said Ely line 105.17 feet to Place of Beginning. ALSO all land between above described parcel and Wly shore of Apple River between N and S line of above parcel extended to river. The purpose of this deed is to survivorship marital property between husband and wife. FLE This ... ............... homestead property. (12) (is not) Dated this .... 19th .. ....... .... day of .......... May .. . . ... ..... .. ......................... ........ ................... . . (SEAL) . .. ...................... (SEAL) • ......... ....... ....... ............. ................... -.-.David. A....Kobs ----- --_---_---_----- ­ ..... ........ ......... ............................... (SEAL) .... . ..... .. .............. ............. .. ......... __ .... (SEAL) ... ..... ......... . . --- _ .............. .............. .... - --------­---- ........... L ----------­-----­--- -------- AUTHENTICATION ACKNOWLEDGMENT Signist ture (a) ....................... .................................... STATE OF WISCONSIN as. ................................................................................ S.t_._.Croix ................ County. authenticated this ._......day of ........................... 19....__ Personally came before me this .____....___.___day of ...... ::nu�_ .4. ................. 191L the above named . ............................................. -------------------------------- . :':� .... Dqvid.'.A..._XoJqIjp ......................................... • .............. ...................................................... ........ ...........•..••..•..•.•.....•....•.•••......... .........•..................... TITLE: MEMBER STATE BAR OF WISCONSIN ............................................................. I .................. (if not, . ........... .......... ............... ---------- ----- --- authorized by § 706.06, Wis. Stets.) to me known to be the person ............ who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY /__ ------------ t Michael E. Sias, PO Box 69 14ew ' .... Richmond, .. wi­54"dD ----------- * ------- ---- ­ ......... Karen .. A1t._ -----------­- ........................... - _-- - -I... I ... .. ....................... ...... .. ­­ ......... ..•. Notary Public --- _$t.? --- CrQiX ------- ..._County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. I If not, state expiration are not necessary.) d-ite . .. ..... ..... ...... ...... --------- -----_----- 19......... KA,, AL'I l4 Pablic - S Of Wisconsin lAy &mmjss+on Expires _'L_! QVrr CLAIM DEED STtTF. FIAR OF WI[SIONMN Wimn—in 1✓•al Alank Co. Inc. FORM 'N�' I — IqY2 Milraukrc, W82. 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 'Avc );�413S residence located at: V �V 1 /4, - N� 1 /4, Section 3 , Town _ N, Range / 3 W, Town of St 04 .-16 , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of service r E, Did flow back occur from absorption system? Yes_ No (if no, skip next line.) -` �a © 1� Approximate volume or length of time: 06 gallons minutes Capacity: &QQ Construction: Prefab Concrete Steel Other Manufacturer (if known). Age of Tank (if known): (License Plumber Signature) (Print Name) m -eks z z3z4z (Title) (License Number) MP/MPRS (Date Form to be completed b licensed lumber s. 145.06 Wisconsin Statutes) p Y p ( or licensed disposer (NR 113 Wisconsin Administrative Code) I I I II �o • �.., CS I � � �3