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HomeMy WebLinkAbout040-1269-50-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 395273 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID Personal irtformatign you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 6--~ Permit Holder's Name: City Village X Township Parcel Tax No: Nelson, Curtis I Troy Township 040 - 1269 -50 -000 CST BM Elev: Insp. BM Elev: I BM Description: � OC>• D t � , � �Y•e•u� — C,-,-71 $ TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic � (� Benchmark Dosing Alt. BM r S. p/ , l o Aeration Bldg. Sewer S. So (06 •o Holding St/Ht Inlet r �.8� X03.63 St/Ht Outlet , TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 7 t Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System f Final Grade PUMP /SIPHON INFORMATION Ma acturer Demand St Cover Model Num r TDH Lift ction Loss System Head TD2 Ft Force in Length 1!! : ,� D�isttoell SOIL ABSORPTION SYSTEM 3 &,,& IM ENC Width ' Length No. Trenches r IT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 91 SETBACK SYSTEM TO rya P/L jBLDG IWELI LAKE/STREAM LEACHING M nufac urer INFORMATION T e Of S stem: CHAMBER OR `D - YP Y e /► � ! r UNIT M el Number: lrM� • 3 " , DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) b L Dia Length Dia pace SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over rr �(( Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center 1 k+ BB Edges Topsoil Yes [N] No � Yes # No COMMENTS nclude de disccrbpen ies, persons present, etc.) Inspection #1: L / O /� Inspection #2: Location: 430 Crocus Hill Road Hudson, WI 54016 (Unknown 17 R19W) Troywood Lot 6 Parcel No: 17.28.19.1482 1.) Alt BM Description = T � ' • �. 2.) Bldg sewer length = 14 ' uUlt4� amount of cover = I LL G Plan revision Required? [ 1 Yes *No � Z1 Use other side for additional information. � Z's 6 � `�� T Date Insepctor's Signature Cart. No. SBD -6710 (R.3/97) 3v Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.2 1, Wis. Adm. Code 201 W. Washington Ave. NVI sconsin See reverse side for instructions for completing this application PO Box 7302 Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Departm of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not 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. Coun State Mary Permit Number ❑ Check if revision to previous application State Plan I. D. Number I. Application nformation - Please Print all Information Location: Property Owner Name // Property Location C GL r f; S L. O r � 1/454A/4, S 17T;40 ,N, F/rE (ot6 Property Owner's Mailing Address Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or CS M Number II. Type of Building: (check one) f ❑ City ,01 1 or 2 Family Dwelling - No. of Bedrooms : ti c ❑ Village ❑ Public/Commercial (describe use):_ Town of 11 State-Owned , Tea y Nearest Ro Z dd All 1 ? Parcel Tax Number(s) V Q - - _ C —Gt7 III. Type of Permit: (Check only one box on line A. a on lin a cable) A) 1. ew 2. ❑ Replacement 3. ❑ Re 5. 6. ❑ Addition to System System Tank On Existing System $) Permit Num er 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: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate . System Elevation 7. Final Grade Required Proposed / Rate (Gals./ ft.) (Min. /inch) / Elevation 440 11 �v S � l �7.� IDo 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 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement / I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (print) Plumber's Signal u o stamps): MP/MPRS No. Business Phone Number Plumber's Address (Street, City, State, Zlip Code) IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issui Agent Signature (No stamps) � kp proved ❑ Owner Given Initial Adverse Surcharge Fee) q De termination $ Z 2,.5 0U / X. Conditions of Approval /Reasons for Disapproval: 1. System shall be installed 2 ft below uniform contour line to ensure adequate separation distance from a limiting factor (see P45). System must also be installed below 2mpl sil horizon (see B1). 2. Effluent filter to be installed and maintained per manufacturer's recommendations. 3. Property is zoned Ag- residential — only one principal dwelling is allowed on this property (see affidavit -�G� SBD -6398 (R. 07/00) i 1- I _I r Septic system plans For Curtis & Lori Nelson Troy Wood Subdivision Hudson WI Prepared by Mike Nelson 715 - 273 -5000 MP #225350 Page 1 Title sheet Page 1 -4 Soil evaluation report Page 5 Surveyor map Page 6-8 House plans Page 9 Plot plan Page 10 System Sizing Page 11 Tank cross section Page 12 Bio Diffuser Page 13 -15 Management plan Page 16 Maintenance agreement Page 17 -18 Warranty deed 1324 Wisconsin Department of Commerce SOIL EVALUATION REPORT P 1 of 3 Division of Safety and Buildings in accordarre witfi `Cpmw 85, Wis. Adm. Code Gustu Septic Service ` County Attach complete site plan on paper not less th '�Yz z 11 inches in size. Plan mu St. Croix include, but not limited to: vertical and hoii ferenoe pant M), direction 'n parcel I.D. percent slope, scale or dimensions, north ap, nd location a tan tone d. pe ndin g 1 11 print foad hE E Please r n ' r R wed By Date. Personal information you provide may be ondary p�aposes (Privacy Law, s. 15.04 t") 9 Property Owner 1 rop�rty ovation Humbird Land Corporation ST CFO/X Gov4,'j` C n/a 1/4 SW 1/4 S 7 T 28 N R 19 W Property Owner's Mailing Address ° ' CADUN I Y L #ti, Block # Subd. Name or CSM# 332 Minnesota Street, East 1404 "`t 20NMJGOFpI� n/a Troy Wood Subdivision City State Zip C Pt1'o Number City J Village Town Nearest Road Saint Paul MN 55101 1- 222 - 555 § - Troy I E Cove Rd / Crocus Hill Road 0 New Construction Use: 01 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD _,.J Replacement _�j Public or commercial - Describe: Parent material outwash plains Flood plain elevation, if applicable n/a General comments and recommendations: Part of 1.95 acres. BM #1= 100.0'. BM #2= 98.6'. Recommend system elevation 99.0'. P45 from preliminary boring work done 5 -5 -00. Addendum to soil test submitted 11- 15 -00. [ F4�6 Borin g # J Boring Pit Ground Surface elev. 100.8 ft. Depth to limiting factor 62 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 PD/fl�E 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-6 10yr2/2 none sil 2mcr mvfr as 2f,1 m 0.5 ✓ 0.8./ 2 6 -16 10yr3/4 none sil 2msbk mvfr cw 1f 0.5,/ 0.8✓ 3 16 -30 10yr4/4 none sit 2msbk mvfr cw - 0.5.i 0.8 ✓ 4 30-62 10yr4/6 none sil 2msbk mfr cw - 0.5 r 0.8 c2 -3d 10 7/2 gyr� sil 1 msbk mill - - 0.2 ✓ 0.3 l 2� Boring # ,j Boring Am Pit Ground Surface elev. 101.6 it Depth to limiting factor >70 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -10 10yr3/2 none sil 2msbk mvfr as 2f,1m 0.5 0.8—' 2 1417 10yr4/4 none sit 2mpl mvfr cw 1f 0.0 ✓ 0.0 3 17 -27 10yr2/2 none sil 2msbk mvfr cw 1f 0-5-- 0.8 4 27-42 10yr4/6 none sl 2msbk mfr cw - 0.5 ✓ 0.9 5 42 -70 10yr5/6 none sl 2msbk mfr - - 0.5 0.9 ZJ �? D 3/. 2 * Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD <30 mg/L and TSS <30 mg/L CST Name (Please Print) Signature: CST Number Tom Gustum 227618 Address Gustum Septic Service Date Evaluation Conducted Telephone Number N13450 937th St., New Auburn, WI 54757 8/24/01 715 -658 -1344 Property owner Humbird Land Corporation Parcel ID # pending Page 2 of 3 Boring Boring # Pit Ground Surface elev. 101.4 ft. Depth to limiting factor t� 2 F >72 in. Sal Application Rata Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots in, Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-4 1Oyr2/2 none sil 2msbk mvfr as 2f,1m 0.5 0.8 2 4 -18 1 Oyr2/2 none sil 2msbk mvfr cw 2m,2co 0.5 ✓ 0.8 ✓ 3 18 -26 1 Oyr3 /3 none sit 2msbk mvfr cw 2m,1 co 0.5 � 0.8 4 26-56 1 Oyr4 /6 none gr. sil 2msbk mfr cw IM 0.5- 0.8 " 5 56-72 1Oyr5/6 none gr. sl 2msbk mfr - - 0.5 ✓ 0.9- Q .0 Boring # � Boring F - 3 - 1 Mit Ground Surface elev. ft Depth to limiting factor 7 - 72 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I .0 - (P /oye 7- ,I ms k rr•v L as iC ,3 13 -Z2 to Lr 2�( y m ore 5i I V Y- 1 �r GO — v •S r p. $ ✓ 4 -ys �•� YQ Lf (o nlawe s- f w. r1n 0'5✓ 0. 0 F-1 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 Roots 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 mgA. 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. + 3 � RiF CA N ' 1 O � � o d — a 3 t �} . 1 C 1 -o 1 ` 0 UQ w c V ol 1324 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Gustum Septic Service 4 Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County St. Crob( include, but not limited to: vertical and horizontal reference pant (BM), direction and Parcel I.D. � percent slope, scale or dimemsions, north arrow distance to nearest road. p endin g '� p g alfin Please prfntkrljkdoh / ,{ By D Personal information you provide may secondary purposes (Privacy Lary s. 15.04 (1) (m)). Z i Property Owner ! i {. i y�' Property Location Humbird Land Corporation :.' ovt. Lot n/a 1/4 SW 1/4 S 17 T 28 N R 19 W Property owners Mailing Address' ' ,' r n v 7 7 �- # Block # Subd. Name or CSM# 332 Minnesota Street, East 1404 , , 6 n/a Troy Wood Subdivision City Stliits Zip Code PWqiyumber _j City _j Village Y Town Nearest Road Saint Paul I Mj 551 "'4W M-5 5 Troy E Cove Rd / Crocus Hill Road 0 New Construction Use: Res' 4./ I�u rooms 3 Code derived design flow rate 450 GPD J Replacement Public ori2ltrnrttr+ClBf= Describe: Parent material outwash plains Flood plain elevation, if applicable n/a General comments and recommendations: Part of 1.95 acres. BM #1= 100.0'. BM #2= 98.6'. Recommend system elevation 99.0'. P45 from preliminary boring work done 5 -5 -00. P45 Boring # J Boring d Pit Ground Surface elev. 100.8 ft. Depth to limiting factor 62 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' *Eff#1 *Eff#2 1 0-6 10yr2/2 none sit 2mcr mvfr as 2f,1m 0.5 0.8 2 6 -16 10yr3/4 none sil 2msbk mvfr cw 1 f 0.5 ✓ 0.8 3 16 -30 10yr4/4 none sit 2msbk mvfr cw - 0.5 0.8 4 30-62 10yr4 /6 none sil 2msbk mfr cw - 0.5. 0.8 ✓ 5 62-68 10yr4/6 c2 5y 0 T7/2 sit 1 msbk mfi - - 0.2 v 0.3 Z b Boring # I Boring 1/ Pit Ground Surface elev. 101.6 ft. Depth to limiting factor X in- Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft= *Eff#1 *Eff#2 1 0 -10 10yr3 /2 none sit 2msbk mvfr as 2f,1m 0.5 0.8 2 10-17 10yr4/4 none sil 2mpl mvfr cw 1f 0.0 V 0.0 3 17 -27 10yr2/2 none sit 2msbk mvfr cw 1f 0.5 0.8 ✓ 4 - 27 -42 10yr4/6 none sl 2msbk mfr cw - 0.5 ✓ 0.9 ✓ 5 42 -70 10yr5/6 none sl 2msbk mfr - - 0.5 0.9 * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 <150 mg/L * Effluent #2 = BOD 30 mg/L and TSS < mg/L CST Name (Please Print) Signature: CST Number Tom Gustum 227618 Address Gustum Septic Service Date Evaluation Conducted Telephone Number N1 3450 937th St., New Auburn, WI 54757 11115100 715 -658 -1344 r prop" owner Humbird Land Corporation parcel ID # pending _ _ Page 2 6f 9_ 2] Boring # Bo __ 1 ring 101.4 ft. Depth to limiting factor >7 - 2 . in. Soil nation Rate 16 Pit Ground Surface slap. — -- __ Application Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots "Eff#1 Eff#2 1 04 10yr2 /2 none sil 2msb m vfr as 20m 0.5 ✓ 0.8 ✓ 2 4 -18 10yr2/2 none sil 2msbk mvfr Cw 2m,2co 0.5 0.8 ✓ 3 18 -26 10yr3/3 none sil 2msbk mvfr Cw 2m,lco 0.5 0.8 4 26 -56 10yr4/6 none gr. sil 2 msbk mfr cw IM 0.5 ✓ 0.8/ 5 56 -72 10y r5 /6 none gr. sl 2msbk mfr - - 0.5 0-9-/ F Boring # Boring j Pit Ground Surface elev. -- Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM •Eff#1 'Eff#2 F Boring # Boring I Pit Ground Surface elev. -- _- _- _._.__ -___ ft. Depth to limiting factor — - - in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots =Ef1#1 •Eff#2 • Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 rng/L " Effluent #2 = BOD < 30 mg/L and TSS < V 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. Y- � c` • • M w Cu �\ ® M #a V V / v � v � v o - q- Q i S � d r f rr � III ` �� � fir✓* A le_� To "A.? . 1 Sizing for 4 bedroom house 1565 Gallion septic tank Zabul A1800 filter 4 bedrooms x 150 gpd = 600 gpd 600 gpd / 0.9 = 666 sq ft 666 / 17.14 = 39 Bio Diffusers Z a. .4 �J, z CQ w� It L p p Z _ Er 0. �' �_ C6 C4 FM 0.z � W r, fin. E W_ W In o cc) � E � LO U a L?I a z p° Z W F- a n-- z "" W . z.l cry a� W. a CO OR-IL 0I ., , d W E G �� a .. 114 E � I a . d �Z�� p 3t d A d da d t!'� E - z Z [ 2. G ,s� J C7 W D 0. �s S/i CA ;7LrL- = LL' a d �O WA,�c. ET. U' d. vz 03 L� WWpa� z A� W a axw ° zcc)�z �U �Cq pad °rr ad Wy;per �_ LO w f �. �. �� ..WW OUWE.�d �,)� FMS C7 W J L� U V 2 x oar c*�� > =�� x� zdW a�wo� vex H W. z:�oa : C Ems W d- � :ZtY1� U .. U' U �AV tlldppWd, W ��dd I xzz 0. xd0. W�mc��: tr�»�r�a uoa.�Wmcv��p d dcoc a a m' Wx c7 p u E A N N m A t v � t t ~ � W x z d x H I N CD 17 �1 8 ° IV Tim COO A U .� CAA i R Y 4 y - -- 76" ofl ool�i T� Chamber 4. _ o0 00 0o coo � ��->> DD OO DD �C' DD OD �� OOI� Height O oo C �R� L_ DD DO DD C� OD OO O a D D CEO 1 - -> 1 } i �r Chamber " Height End View x 34 3 s 4" Knockout `�'. ., ... Universal End Cap er Available Sizes Chamb 1 N Dimensions Standard Ca �aciity Length 96" 76" 76" WWdth 34" 34" 34" Hni 11" „ 9 14 16 Invert 6.5 9 11.3 Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number Number of Bedrooms Design Flow - Peak (gpd) Estimated Flow - Average (gpd) 600 Septic Tank Capacity (gal) �S Soil Absorption Component Size (W) Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) p Maximum Influent Particle Size (in) 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the 3 epl-le� Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The tic tan shall a septic h ll h ve its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 I Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep- rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. S 70 Aoa, V Z•a (,/ /"' � %'rr 4 / eao Yx 11 y �- 7 /S- z 73 - < -00 3 i �s�l� CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: 7 A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption \ system. The replacement area should be protected from disturbance and compaction and should not be Infringed upon by required setbacks from existing and proposed struewre, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems roust comply with the rules In effect at that time. I7 A suitable replacement area Is not available due W setback and /or soil limitations. Barring advances In POWTS technology a holding tank may be Installed as a last resort to replace the failed POWTS. 0 The site has not been evaluated to identify a sultabte replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable repiaceRwnt area. If no replacement area Is available a holding tank may be insulted as a last resort to replace the failed POWTS. D Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the Infiltrative surface. Reconstructions of such systems must.comply with the rules In effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT", RESCUE OF A PERSON FROM TI(5 INTERIOR OF A TANK MAY BE DIFFICULT OR INIPM IR1 F. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Na me Phone Phone SEPTAGE SERVICING OPERATOR (PUMPE!j LOCAL REGULATORY AUTHORITY Name [ -- Agency S7: Phone n t — L SEP -10 -01 12:24 PM NELSON 6124322893 P.01 September 10, 2001 Mr. Jon 5onnentag 5t. Croix County Hello Jon. Per your request for clarification (for zoning Purposes), the garage studio is intended to be a "mother -in -law" unit, to be used by only one, Person at a time on an as needed basis. Please call if you require further information or have additional questions. Thank you. Lori 4 C.J. Nelson (GS 1) 735 -7218 656228 A : iI L f E R O WALSH VOL 1716PAGE 133 DEEDS REGISTEf� O F DEEDS ;ST. CROIX CO., WI Document Number Document Title RECEIVED FOR RECORD 0'?-11 -2001 8:45 AM St. Croix County AFFIDAVIT :X-;PT D S@Condaty Living Quarters Affidavit CERT COPY FEE: C iFY FEE: 2.00 TRANSFER FEE: t�J (A)e -1 1 5 + LOA 1 PES: &6OX) PA G' �u Fc:: 11.00 Ai,ES: 1 Name — (Owner) Typed or printed being duly sworn , states, under oath, that: 1. He /she is the owner /part owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume 1 ? it) Page Document Number i t. Croix County Register of Deeds Office: Recordinq Area Name and Return Address A parcel of land located in the ' /4 of the _ V4 of Section OOP T ,V IV4 L.S T N— R W, Town of `r oz)K , St. Croix t'd q X fe /1-1J 4e G P R County, Wisconsin, being duly described as follows (include lot no. and subdivision/CSM or detailed legal description): L; v T _ RA L &,, j) , T ocv.v o f _ P, K S t C Ro" k GOL/y T r ' , Parcel Identification Number (PIN) , 1& i S GaN I �/ As owner of the above described property, I acknowledge that the St. Croix County zoning ordinance prohibits the creation of two- family dwellings (duplexes) on Ag- residential property without first obtaining a special exception permit. The proposed seco ' n . rs for the above mentioned property above the garage will only be inhabited by persons related to individuals residing in p I I understand that the secondary living quarters may not be rented out in the future to any individuals not related to I also a II that I will make this information available to any future parties interested in pruchasing this property. SEP e � Dated this day of _ 5 5 7— cl:� SAY / ZONINGOCE %may y-' * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) )ss. authenitcated this day of St. Croix County. ) Personally came before me this day 0 ► the above named AA 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. Slats.) instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY � �, �J (: T i S J /I/ �, t'./'✓� `�, ; 2 m f * �&r� n - lrJaksA Si natures may be authenticated or acknowled ed ;�Be�h•ar V Notary Public, State of Wisconsin ( g y g ry c�iot 4 O My Commi s s7 n is ermanent. If not, state expiration date: necessary.) .(6;'•••••• •• Da "THIS PAGE IS PART OF THIS LEGAL DOCUMENT — DO NOT REMOVE" This information must be completed by submitter.• document title. name & return address, and PIN (if required). Other information such as the granting clauses, leagal description, etc. may be placed on this first page of the document or may be placed on additional pages of the document. Note: Use of this cover page adds one page to your document and $2.00 to the recording fee. Wisconsin Statutes, 59.517. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer V V R T ) r S /U Qj bo A; Mailing Address O 1 Z , D P'1'(i' Property Address /-3e) r co—CUs h ,' roa- c� (Verification required from Planning Department for new construction)_ City /State tj .z Parcel Identification Number LEGAL DESCRIPTION Property Location V4, V4, Sec. / 7 om , T N -R.L Town of �'© Subdivision rv v L, 2004 , Lot # Certified Survey Map # Volume . Page # Warranty Deed # , Volume , Page # Spec house ❑ yes JO no Lot lines identifiable 0 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 P PC1h' owner green to submit to St. Croix Zoning Department a certification form, signed by the owner and by a ro g ve ' 1 master plumber, journeyman plumber, restricted plumber or a licensed pumpe r nfying that ( ) the on -site wastewater disposal 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. /� t? l3il .4 LQ - SIG ATURE PLICANT 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 recorded in Register of Deeds Office. above b virtue of a warranty deed g the roe described ty property rty SIGNA F PLICANT DATE ** **** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Departm ** 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 r � STATE BAR OF WII'. SI RM 2 - 1998 WARRTY. ED KATHLEEN H. WALSH REGISTER OF DEEDS Document Number ?' ST. CROIX CO., WI This Deed, made between Humbird Land Corporation, a RECEIVED FOR RECORD Minnesota Corporation { 08 -30 -2001 12:10 PM .,`.� WARRANTY DEED Grantor, and Curtis J. Nelson and Lori A. Nelson, husband and wife EXEMPT R CERT COPY FEE: COPY FEE: 1RANSFER FEE: 221.70 RECORDING FEE: 10.00 PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: Recording Area Name and Return Address Lot 6 Troy Wood, Town of Troy, St. Croix County, ' Wisconsin G "/c 1/4 / Goa /Go 040 - 1269 - 50-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Subject to notes, easements,restrictions,covenants and rights of way of record, if any, including but not limited to those for drainage,water retention,ponding,and or utilities as may be shown on the plat of Troy Wood recorded in Vol. 8 of Plats, page 28,St. Croix County, Wisconsin. The warranties of this deed, either expressed or implied are limited by the grantor to the grantee, or anyone in the chain of title, to the consideration expressed herein, that being the sum of $73,900.00. Dated this 23rd day of August , 2001 Humbird Land Corporation * * by C�,�� ` President * * Austin J. Baillon AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) ) SS. Signature(s) Ramsey County. ) Personally came before me this 23rd day of authenticated this day of August 1 2001 the above named Austin J. Baillon * TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not, instrum nt and acknowledge the same. authorized by § 706.06, Wis. Slats.) ���. ■ ■ THIS INSTRUMENT WAS DRAFTED BY PAULA. BAILLON Paul A. Baillon, Attorney at Law * Paul A. Baillon NOTARY PUBLIC-MINNESOTA Notary Public, State of Wiscons' lal (Signatures may be authenticated or acknowledged. Both are not My Commission is permanent. necessary.) January 31 2005 ) "Names of persons signing in any capacity should be typed or printed below their signatures STATE BAR OF WISCONSIN WARRANTY DEED FORM No. 2 .1998 INFORMATION PROFESSIONALS COMPANY FOND DU LAC, WI 800- 655 -2021 ., . 1.87 ACRES a" RES `d. 1 ,.. r o W- lo, -95 ACRES 83. SO. FT. 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