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040-1184-40-000
I, 0 ~i (D a O c I I CL v c rn c a~ 0 T N y. m LO C ~ a .5 H r d eL o 0) F- oto J Y in o co ' M ` N N CL (D C °z ~E a) (D c) E M O ~ O RUC A to Nw O N N CL N N O N i Q) N I Y O O O 'O 'O c Z n> 0 z y O N L 22 O LL c N p C LL c N c h N O U '00 OD (D a ' O Q o o 0 0 M ° ~ 'vi I z iri I C) M E E ` ° J o` a € v am am I I E z a' N 7 y a~i Z ~ c ~ c I N ~ c ` •7 N 7 O d O O = Z Z° Z Z Z N rn R ~ R I ~~1 2 ! 0 4 w O w c. a~+ c j d a0. N 3 v lC 7 d N 0 o = G o a EI = G O a °c ° v r m ' r II X 3 3 3 a~ I~ 3 3 3 a~ •N 4i 0a.Maa 0000 U y U a a a a ~1 7 O U) ! O° O y y CO O O N J U CN7 N N M O Z O O O O w O L O~ Z O N LL 0) 0) a m c a a m' c ca .2) -64 m a~i Q n in m a z w h ' w y T N C ° ! U H C O E U O 'O 'O Cl) O ° o co 16 0 r \ n c Z O c c ~.0 N z y c c v O c° o c o d a~ 4w 2 N V - 7 C co U) ~ O N T N M E E O L N O` h O3 lE • o ff N v 0 Z N d d U U )l o z° N z z C%1 y a a • c. d r~ m c r A ciao 0aici 0U)L) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 483974 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Zitzewitz, Nancy Jean & Peter F. Troy, Town of 040-1184-40-000 CST BM Elev: Insp. BM Elev: BM Description- Sectionlrown/Range/Map No: 0 ' / 13.28.20.750 TANK INFORMATION ELEVA ION DATA TYPE MANUFACTURER CAPACITY STATI BS HI FS ELEV. 10 6o, Septic Benchmark 77-37"_ /o 3 f Od U Dosing Alt. BM Aeration BId olding S nlet' / 3U~ ~ ~c-Tr 0 _j ~319,b TANK SETBACK INF TION ~Q TANK TO P/L WELL BJ LqG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. Aeration Dist. Pipe Holding i ~~b r ZD 1©f 15t/ Bot. System Final Grade--[--' PUMP/SIPHON INFORMATION 1 S- Manufacturer Demand t v r / Z.Ip 9CP, GPM l r 6v1. ry A" Model Number TDH Lift on Loss tem Head TDH Ft lm _ Forcemain Length Dia. Dist. to Wel ay kh' SOIL ABSORPTION SYSTEM BED/TRENCH Width :r~~ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. T id Depth DIMENSIONS SETBACK SYSTEM TO P BLDG WELL KE/STREAM /LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT > / 00 , Model Number: DISTRIBUTION SYST SC~/~%0 /d Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air In fake Pipe(s) Length Dia Length Dia Sp ' 90 f SOIL COVER x Pressure Systems Only and Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded T Mulched Bed/Trench Center Bed/Trench Edges Topsoil Ful Yes ®No ®Yes C No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:13 /IA-/ f Q Inspection #2: Location: 328 N. Cove Rd. Hudson, WI 54016 (Gov't Lot 3 13 T28N R20W) Bomar Heights Lot 4 ~pftti~s Parcel o: 13.28.20.750 1.) Alt BM Description= / 2.) Bldg sewer length = - amount of cover AfW C41,4VJ 22`'&,"4S (J 1 ~ Plan revision Required? ® Yes %^vc Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor's Signatur Cert. No. commeme.W1.90v Safety and Buildings Division County 201 W. Washington ~ft P.O. Box 7162 St. Croix i sc o n s n Madison, 07 62 Sanitary Permit N ber (to be filled in by Co.) Department of Commerce 3 Sanitary Permit Application State Transaction Nun►berA~Z n In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate gov ental Project Address (if different an mailing address) unit is required prior to obtaining a sanitary permit. Note: Application forms for stagte ~oPOWTS are submitted to the Department of Commerce. Personal information you pr Ws or secondary same purpo ses in accordance with the Privacy Law, s. 15.04 1 m , Slats. FIr I. Application Information - Please Print All Information Property Owner's Name S Parcel # Peter & Nancy Zitzewitz 040-1184-40-000 vp~ Property Owner's Mailing Address S-T CROM CE Property Location 328 North Cove Road pI,ANNING 11 ZONING OFFI Govt. Lot City, State Zip Code Phone Number NW '/4. SE '/4. Section 13 Hudson, WI. 54016 715 -386-3062 (circle one) IL T We of Building (check all that apply) - Lot # T 28 N; R 20 W • 7~ 4 Subdivision Name or 2 Family Dwelling -Number of Bedrooms j / Block # Plat of Bomar Heights El Public/Commercial -Describe Use Na ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of Na ❑ Town of Troy III. Type of Permit: (Check o one box on line A. Complete line B if a licable) A. ❑ New system Replacement System Treatme t/Holdin Tank R lacement l y Modification to Existing System stem (exPlain g eP ~ Y El S Y ) 8 ❑ Permit Renewal Permit Revision 11 Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued ❑ n , Before Expiration Owner IV. Type of POWTS S stem/Com onent/Device: Check all that a 1 ❑ n-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (st) System Elevation 450 gpd Na Na Na 86.50' VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units" o v New Tanks Existing Tanks y o Y' Y rue 0. U C40 V3 is, C7 G. Septic or Holding Tank 3,000 a 3,000 1 Wieser Concrete X Dosing Chamber Na Na Na Na VII. Responsibility Statement- I, the un rsigned, as me responsibility in tion of the POWTS shown on the attached plans. Plumber's Name (Print) turn is Sign MP/MPRS Number Business Phone Number James K. Thompson MPRS 30021 715 248-7767 Plumber's Address (Street, City, State, Zip Code 340 Paulson Lake Lane, Osceola, W 54020 VIII oun /De artment Use Only Approved 11 Disapproved Permit tFFeJey Date Iss d I ;~mg en Sign ` ❑ Owner Given Reason for Denial $ b`; f IX. Conditions of Approval/Roasons for Disapproval or~ SYSTEM OWNER: c~~L ~CC 1 Septic tank, effluent filter and f~ dispersal cell must all be serviced / maintained 4 U as per management plan provided by plumber. . 2. All setback requirements must be maintained Ll~~76 6, LtlQQ Ga-~ as erapplicable code/ordinances. Attach to complete plans for the system and submit to the County only on paper not less than 81/2 x 11 inches in size SBD-6398 (R. 02/09) Valid thru 02/11 HOLDING TANK COMPONENT CHECKLIST 2008 o-1 [ Holding Tank Component Manual SBD-10571-P(R.6/99) [ ] Holding Tank Component Manual SBD-10855-P(N. 03/07) GENERAL SUBMITTAL INFORMATION YYN N//AA U (9 Plans and specifications must be complete and clearly legible and drawn in permanent ink or photocopied. Submittals must be on paper measuring at least 8-1/2 by 11 inches. V✓O All signatures are required to be original ink. V/O O Index pages require the owner's name, manual name and SBD no. and legal description of the project. O O 1 Plans not using an index page are required to have every page signed and dated by designer/plumber. O O O/Plans not using an index page require the name of the project, legal description and name of the manual shown on the plot plan. ~O O All designs shall be signed by an individual who posses a valid credential for designing a POWTS. OILS INFORMATION , he O O A properly completed soil test must be included as per county policy. PLOT PLAN MUST INCLUDE: V /0 O Plans that are fully dimensioned or drawn to scale (scale indicated on plans) with all property / boundaries clearly marked or parcel size shown. (fir O O A benchmark & a north arrow. V //O O Proper setbacks as established by appropriate code; (see Table 83.43-1) V O The legal description of parcel/location information. O O All nearby existing system(s) or well(s). O O Reference to OHWM * when near floodplain boundaries or bodies of water. (ex. - reading of lake elevation vs. ground elevation at/near the tank). *OHWM = Ordinary High Water Mark O O A service drive/pad located within 25 feet of tank service manhole(s) must be identified. SYSTEM SIZING: 1P//O O For one and two-family dwellings the number of bedrooms must be indicated; (ex: 2 bedroom estimated = 200 gpd x 5-day) = 1000 gallons; The manual requires a tank size of not ss than 2,000 gallons. O O Public building review require state review unless you are a designated POWTS agent; tank sizing calculations per Table 3 published in the manual, must be included. (ex: total estimated daily flow x 5-days) = min. tank capacity required; The manual requires a tank capacity of not less than 2,000 Ilons. O O Sizing based on per capita occupancy or by meter-reading instead of estimated flow require that a deed restriction be filed with the county. HOLDING TANK COMPONENT CHECKLIST PAGE 2 Y N N/A I TANK CROSS-SECTION MUST INCLUDE: O O The cross-section detail must contain information regarding tank size and manufacturer, liquid depth below the inlet, depth of high water alarm, (1' below inlet), approved joints/piping material and any modifications (suction pipes, etc.) shall be clearly marked. O O O/Anchoring calculations if applicable when tank(s) will be located near bodies of water or low, saturated conditions; O O ~Q/Anchoring calculations required for all tanks located in the 100 year flood plain when submitting per component manual SBD-10855-P N03/07. MANAGEMENT PLAN PER COMM 83.54, W.A.C. MUST INCLUDE: 0/0 O A management plan that contains information on the periodic inspection, maintenance and servicing /0 of the component including electrical & mechanical components must be included with the plan. fY O ~/The procedure for abandonment of the tank(s) must be included. O O management plan must also address tank servicing when the elevation between the bottom of the tank and the pump pad is greater than 15 feet vertically. SEPTAGE DISPOSAL: ~f O O A written statement from owner regarding method of final disposal for design flows less than 33,000 gpd is required for component Manual SBD-10571-P(R.6/99. O O Q /Flow rates of > 3,000 gpd require state review unless you are an agent; written verification from DNR is required for these types of submittals. ISCELLENEOUS O O State POWTS staff shall be contacted for any plan that includes combined kitchen & sanitary wastewater or Industrial & sanitary wastewater designs. These plans may require a state level grease interceptor review or DNR concurrence per Commerce MOU with the DNR before the plan can be approved. I I CONCRETE HOLDING TANK DESIGN Single Tank Option INDEX AND TITLE SHEET Project Peter & Nancy Zitzewitz 3 bedroom residential Holding Tank Owner Peter & Nancy Zitzewitz Address 328 North Cove Road Hudson, WI 54016 Legal Description NW1/4 SW1/4, Sec. 13, T. 28 N., R. 20 W. Township Troy County St. Croix Subdivision Name Plat of Bomar Heights Lot No. 4 Parcel ID Number 040-1184-40-000 Plan Transaction ID Number Index and title sheet Page 1 Holding tank specifications Page 2 Site plan Page 3 Maintenance and contingency plan Page 4 Holding Tank Agreement Page 5 Holding Tank Servicing Contract Page 6 Holding Tank Cross section Page 7 Deed Page 8 Designer James K. Thompson Signature Phone No. (715) 248-7767 License Number Dep't. of Comm. Credential #30021 Date 08/31/10 Designed pursuant to: Holding Tank Component Manual For POWTS SBD-10571-P (R.6199) Version 4.0 (04103) Page 1 of 8 HOLDING TANK SPECIFICATIONS 3 Number of bedrooms 0.0 Non-residential estimated flow (gpd) 2000.0 Minimum holding tank volume required (gal) 3000.0 Proposed holding tank capacity ( al) Wieser Concrete Tank Manufacturer WLP 3000 Tank model number JH Rhombus Alarm manufacturer SJE 1011421 Alarm model number Tank Dimensions and Data Tank Anchor Calculations X for round tank 25030 lbs Weight of tank and cover 45.0 Liquid depth below inlet invert (in) 1.50 Safety factor 7.0 Maximum de T h of soil cover (ft) 36728 Ibs Weight of anchor required 60.8 Height (in) Outside 29.5 in Soil cover req. for anchor or 184.0 Length (in) Dimensions 9.1 yd's Concrete counter weight 102.0 Width (in) Only HOLDING TANK CROSS SECTION manhole cover with locking device and finished vent cap junction warning label grade ~4-11 box ~l 4" min. 12" min. L_ L 24 in. Manhole and vent locations conduit vent pipe 18" min. service ~ 12.0 In. - inlet building sewer blind plu alarm on Note: All tank joints, and 9 to seal )joints between tank outlet openings,and piping are Electrical as per 33.0 in. sealed watertight. All NEC 300 pipe and vent materials and Comm 16 comply with Comm 84. 3 in. bedding under tank. Tank is anchored as necessary to negate buoyancy. Project: Peter & Nancy Zitzewitz 3 bedroom residential Holding Tank Transaction Number: Page 2 of 8 ♦ EX/s6,7,y~~a~e e!~r UanC.~ Yy(rrr~' e: ~z yd afo ~,ol~n a /l cv. Car.tier 9wra2. !e~• /GO.Ct? e 3.28 /10. Covc lea! f/ccalto•~ c.J/ S/O/~ T, o~oy,St.CroiX~,, cJ/. /~el. NCO ~/D -//Bf/- yo-ax; be%~r a /cam EX%.sti~~ d~ywe!/s. ►1e;~fibor' s6ea."~ ~tS.dewct dliuewa~y EX,3fi S&~lScpbLfa, r .tr The &s 83.r°te p 0 ' ra+av~•d hC ri Gc9~ll o r A ys/s, o Mc~ r~ 5loats 4.r`\l~ Ea GeS `~4pt S/opts ./B ~ 9~ L_/1 0.4 ma:&W ~o driae" a.t -so I eo sly,-e/,Ke , L y. ! a' a fir ~ b o ~Pprax imaEe Jo capon -,C Pr o po:s d Zres.~ ca"? C. wL103 009o-P. kel- ~q{-,I<. nti ikbon-i Bu,"ldW10 sew,. 6a~dl /es,dcacL 6~.d.01. iilsu.(4liesi 61.17 el -6i dr,'✓e wayy a s /-r 3o6 1)(C, , HOLDING TANK MANAGEMENT PLAN This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and maintained according to Comm 83, Wis. Admin. Code, the Holding Tank Component Manual (SBD-10571-P 6/11/1999), and the St. Croix County Sanitary Ordinance. 1. This POWTS is designed to accommodate an estimated domestic wastewater flow of 600.0 gpd. 2. The owner of this POWTS is responsible for system operation and maintenance, including all provisions in the attached Holding Tank Servicing Contract and Maintenance Agreements. 3. Each time the wastewater in the tank reaches 90% of the tank(s) capacity or a level of 12" below the inlet (at which time the alarm will activate), the pumper listed in the current Servicing Contract must be called to empty the tank's contents and dispose of them in accordance with NR 113, Wis. Adm. Code. 4. At each service event, the service provider should visually inspect the condition of the tank, risers and manhole cover(s) and verify that the alarm system functions and manhole locking devices are present. Discrepancies are reported to the owner in a timely manner for corrective action. All corrective actions shall comply with the county sanitary ordinance and Comm 83 and 84 Wis. Adm. Code. 5. All service events or inspections of this POWTS shall be reported to the county within 10 business days. 6. The owner may not remove any of the wastes from the holding tank(s), or cause such wastes to be removed by any person not authorized to do so under Ch. 281, Wis. Statutes. The discharge of wastes tank to the ground surface, including intentional discharges and discharges caused by neglect, constitutes a failing POWTS and may result in issuance of correction orders or a citation by the county or state. 7. No one should enter a holding 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. 8. In the event that this POWTS fails and cannot be repaired, a code compliant replacement holding tank may be installed in the same location (a new sanitary permit is required for such a replacement). Con- nection to municipal services would also be considered at this time if they are deemed available to the property. 9. If this POWTS is replaced, or its use discontinued, components no longer in use it shall be abandoned in accordance with Comm 83.33 Wis. Adm. Code. 10. If there is a problem with, or question about this installation, the following persons should be contacted: a. Installer James K. Thompson Phone: (715) 248-7767 b. Service Provider Tri-County Sanitation Phone: (715) 386-2130 c. Co. Zoning or Health Dept. St. Croix Co. Zoning Dep't. Phone: (715) 386-4680 11. Project: Peter & Nancy Zitzewitz 3 bedroom residential Holding Tank Transaction Number: Page 4 of 8 SEPTIC or HOLDING TANK SERVICING CONTRACT Contract Date This contract is made between the Tank Owner(s) Name(s) and Pumper's Name - c Jidgi We acknowledge the installation of (a) septic/holding tank(s) on the following property: (Provide legal description): o0 f• /o-e t x - 63 7-28/6,Z0&2 7n--, 2o -E.. C Cz• (c)l L.o~ ~ a ai• e.'a~,5 1. The owner agrees to file a copy of this contract with the local governmental unit (St. Croix County Planning & Zoning Department) to document maintenance by a certified septage servicing operator as required in Comm 83.52(1)(c)2. Wis. Adm. Code and the approved Component Manual. 2. The owner agrees to have the septic/holding tank(s) serviced by the undersigned pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the septic/holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the septic/holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the septic/holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local governmental unit (St. Croix County) a report for the servicing of the septic/holding tank(s) on a monthly basis. The pumper further agrees to include the following in the monthly report: a. The name and address of the person responsible for servicing the septic/holding tank; b. The name of the owner of the septic/holding tank; c. The location of the property on which the septic/holding tank is installed; d. The sanitary permit number issued for the septic/holding tank (if known); e. The dates on which the septic/holding tank was serviced; £ The volume in gallons of the contents pumped from the septic/holding tank for each servicing; g. The disposal sites to which the contents from the septic/holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the local governmental unit named above within ten (10) business days from the date of change to this service contract. Owner(s) Name(s) (Print) Owner's Signature(s) Subscribed and sworn to me on this date: ay's Date Pumper's Name (Print) P mper's Signature Pt6tary Public Signature Pumper's Registration Number Commission Expiration , A~0 8 604° 48" A 102" U Z n rn m I.I I I ~ 1 3" I I e `,rr O I I 514„ 6" 0 fTl ~ p < < I I 07 F ~Om I I ~ \ II 1 II / Z D II" II x 46'. u _ u m -~I O C C) C r L N ~ C ~ D > O K n Z N ~ ~ ~ ~ = r r Z Z p m N y Z Z O O O r r D n D Z 0 c m --I m m z >z z O ZT n D Z D OZ Z ° ~~~rt~~r2~n W mZ zF7, ncn O n O-Z> Z - mmOrp Z mDO Or-0 M m D prN CmD O =npxnp==Y0:E :1 TT;u Orc/1 C m n nm T > m z N D m0 0mD O.-- TAO ~w ~ C z , T( D O ~ Z m n r (D ' r*) m. Co N m m m O D O v m O D D -~M w Wr, a wA D U n Cr) X N D f< Z O 0 < M - -I AAOOp:_ <n O T7 m n 'D NfmrlW 11 O m m z N r 0 DD L000 O 0 ° *m 0 m°~ Ir K. o n0 r Oz M Z 0 mL>--A mm00 00 0 oA D D O m D 0 m 0 N p D 2 r Z >0 ~ W w O n cn ~m c z>-- 0 y Cw vAi O n O CA O D ~O, O;:a r r z Z O D -i r -i m co r W O N m V_1 cf) O p ~ O c z v rN n r Z A D n A m cn 0 m r- A m n z A c m O O r A A n O < [A X A m m ~ z n Z r cn m WLP3000 MIESER COOCAETE SCALE: 1/4" = 1' REV NO. DATE: O m DRAWN BY:SWT J \o SEPTIC MANUAL W3716 US HWY10. MAIDEN ROCK, W 54750 DATE: JANUARY 2008 REV, JAN. 2008 800-325-8456 FILE:WLP3000 Pa. 70~' 8 Y '~-aa~~tV.''p'Ttil~" _ ~Te~"s*~c Rear m eox xceau.E,ltia,ukrr~ ST.CvCRC21 XC0 ~Y'Y1&~ _ _Z,-- P7aoCg J~$a1. itZtLlVltz r_. - = g' 11 fr - - - - ° - ~c f?mcord 1_flili 4t1 geit ,ta fFaac _^3gan Litzewi t2 altd Peter F - 1 y pf Ocr A D, ~85 Z~tzel±t~z.,_.ht.s~band- an.i va.r€ _~.s _jQ~~.__teaaRat~ 2:.10 P - ~ - - y ( - {E _ fMbt_wf O~adi - - = - - - - - - f the !allowing described real estate in .5•C_ -.GTO1i&............. County, State tate of Wisconsin: - RRVRN To - ~ _ Loc Faur.(4), Bomar HeIghts, Troy Township, according ' - - to the plat thereof on file and of record in the office of the Register of Deeds within and for said county. Subject to Restrictions and Protective Covenants of Tag Parcel No_______________________________ record. _u 0 This is not homestead property. . (is) (is not) Dated this $th...... I..... October 84 day of ~ 18-•---.... .................................(SEAS,) _.l..~~~?~`f~ SEAL) - * _Nancy-...Iean..2 RX-a-witz........ ..................(SEAL) ---....---..(SEAL) AUTHENTICATION ACENOWI-MDOMENT MINNESOTA Signature (s) Nancy Jean Zitzewitz STATE OF I ?0t SS. i - --°----------•-------°----••------__County. authe7f"Ica this 3-$-,:lay 19.84- Personally came before .me this day of / _ 19 A..__ the above named n._.....--•-- TITLE: MEMBER STATE RAP. OF WISCONSIN (If not. authorized by § 706.06, Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY J,oR,g,•A,--Murray_of•-t1Ei~WOOD,- CAR2 & MURRAY P-.O.__Box -229_, Hudson, kII 540-16 . - Notary Pubh Coonty, 3WI ON (Signatures may be autbentiea.ted or acknowledged. Both Ky Commission is permanent. (If not, state expiration are not necessary.) date: kn QUIT CLAIM DEED STATE BAR OF WISCONSIN - wi....Vn LmM Blank Co. I.e. . FORM NO, 3=1982 Wj .ukee, Wis... ~V}'V S , • I 8 0Tx:4004015 2 Document Number Document Tale 921102 St. CROIX County BETH PABST Holding Tank Agreement REGISTER OF DEEDS ST. CROIX CO., WI Permit Number - RECEIVED FOR RECORD 08/20/2010 4:27 PM EXEMPT N/A Name - (Owner Typed or printed REC FEE: 30.00 being duly sworn , states, under oath, that: PAGES: 1 1. He/she is the owner/part owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume Page (o ~o Document Number O252Mt. Croix County Register of Deeds Office: GOD. /o~- 4 Recordl Area A parcel of land located in the - '/4 of the - %4 of Section Name and Ratum Address T 28 N - R .7,0 W, Town of boy ~ Y ? ~rd St. Croix County, Wisconsin, being 3 Omy described as follows (include lot no. and subdivision/CSM or V"zd$cft L'O/' f"1014 detailed legal description): O 00 - 8 - 1A 0 - Parcel Identification Number (PIN) Agreement Date: eaP/O We acknowledge that application is being made for the installation of (a) holding tank(s) on the above described property or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of sewage. Also, the property Cannot now be served by a municipal sewer, or any other type of private onsite wastewater treatment system as permitted under Ch. Comm 83, Wis. Adm. Code, or Ch. 145, Wis. Stats. As an inducement to the county to issue a sanitary permit for the above-described property, we agree to do the following: Owner agrees to conform to all applicable requirements of Ch. Comm 83, Wis. Adm. Code relating to holding tanks. If the owner fails to have the holding tank properly serviced in response to orders issued by the governmental unit or the Department of Commerce to prevent or abate j a human health hazard as described in s. 254.59, Stats., the governmental unit (Town) may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.0703, Stats. 9. The owner agrees, pursuant to s. Comm 83.54 (2), and Comm 82.40(3)(e), Wis. Adm. Code, to have a water meter installed in the structure. The water meter shall be installed by a plumber authorized by the Department of Commerce to make such installations, with said installation complying with State regulations and manufacturers specifications. The owner agrees to be financially responsible for the purchase, installation, maintenance, and repair of the water meter, and agrees to allow the governmental unit or the Department of Commerce to enter the above-described property on a regular basis to read and/or inspect the water meter. 3. Owner agrees to pay all charges and costs incurred by the governmental unit or county for inspection, pumping, hauling, or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any human health hazard caused by the holding tank. The governmental unit shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. 4. The owner, agrees to contract with a person who is licensed under Ch. NR 113, Wis. Adm. Code, to have the holding tank serviced and to file a copy of the contract with the governmental unit. The owner further agrees to file a copy of any changes to the service contract, or a copy of a new service contract, with the governmental unit within ten (10) business days from the date of change to the service contract. 5. The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code, who shall submit to the county on a semiannual basis a report detailing the servicing of the holding tank. The governmental unit or county may enter upon the property to investigate the condition of the holding tank when pumping reports and meter readings may indicate that the holding tank is not being property maintained. 6. This agreement will remain in effect only until the county office responsible for the regulation of private onske wastewater treatment systems certifies that the property is served by either a municipal sewer or a private onsite wastewater treatment system that complies with Ch. Comm 83, Wis. Adm. Code. In addition, this agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by reference to the property. 7. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit this agreement to the register of deeds, and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of the agreement to be determined by reference to the property where the holding tank is installed. Owner(s) Name(s) - Please Print Subscribed and swom to before me on this date: A fib e~i uN N'S Notary I ~1 J 01 Govern ntal Unit Offi ame, Title -Please Print ommission Expires Govemme Unit Official S n *re Drafted by: Personal information you provide may be used for secondary purposes [Privacy Law s. 1 .04(1)(m)) "THIS PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE" 1 f7ps information must be completed by submi#W.. document title. name & return addres, . and PiNilf required). OMerinthrmadon 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 &t& Use of this cover page adds one page to your document and 52.00 to the recordirro fee. tMsconsin Statutes, 59.517. ~I _ I l H. RECEIVED TOWN -f TROY FEB 18mi S7. CR01X COUNTY 654 Glover Road, Hudson, WI 54016 PLANNING a ZONING OFFICE Phone: (715)425-2665 Fax: (715)425-2551 February 17, 2011 Ms. Carrie Stoltz Water Management Specialist 890 Spruce Street Baldwin, WI 54022 Re: Riverway review/public hearing for an after-the-fact permit for a holding tank installation - Peter & Nancy Zitzewitz, 328 N Cove Rd.; The following comments and decisions were made by the Plan Commission and Town Board at their February meetings. Please retain this document, along with previously provided materials, for your files. Public hearing and Plan Commission Comments of February 3, 2011 Rob Jones. stated that the applicants have applied for an after-the-fact permit for filling and grading in a permitted area for the purpose of installing a private waste water treatment system. During concept review the Plan commission determined that all materials necessary to make a complete application had been submitted. The applicants were not in attendance. Ray Knapp opened the public hearing for an after-the-fact permit for a holding tank installation - Peter & Nancy Zitzewitz, 328 N Cove Rd. at 7:10 PM. No one came forward. The public hearing was closed. Jan Cuccia reviewed that this was an emergency action to replace a failed septic system, that during site review it was evident that the applicant had done a good job of restoring the site and was that she was comfortable recommending approval to the board. Paul Mahler moved that the town Plan Commission recommend approval to the Town Board for an after-the-fact permit for a holding tank installation for 328 N. Cove Road. The emergency or unexpected nature of the failure of their system has created the need for an after-the -fact permit as opposed to going through the normal procedures and that the work that was done had no impact on the view and preservation of the river and would certainly help the river by making a better waste water system, and along the lines of these points certainly the new and up to date system will maintain the health of certainly that lot and the community surrounding that lot an and we talked about water pollution from the river, there was no erosion that we was when we were out on site to speak of they did a good job of handling Y that and the site's. been re=vegetated so there was httle long term impact to terrestrial or aquatic habitat the area does not impact future roads and it certainly was compatible with the adjacent land uses, it's all residential area out there. Based on that I recommend approval. Joe Duerre seconded. Motion passed, all in favor. Town Board Minutes and Motion of Febrnary 10, 2011 Rob Jones, Cedar Corp. summarized that the applicants are seeking an after-the-fact permit for filling and grading in a permitted area for the purposes of installing a private waste water treatment system. The reason it is an after-the-fact application is because the septic failed and needed emergency repairs before an application was filed with the town. A complete application was made to St. Croix County and a permit was issued, prior to the installation of the holding tank. The town Plan Commission has recommended approval of this application. Jim Thompson, the master plumber that installed the holding tank was present to answer questions from the board. R. Knapp asked if all of the other required permits were obtained prior to the installation of the tank. J. Thompson said that they were. He didn't know that they needed a town permit until the day they started replacing the failed septic system. R. Knapp moved to approve an after-the-fact permit for a holding tank installation at 328 N. Cove Rd. Prior to installation, the applicant had received all require permits from the county and an unexpected failure of the system created the need for an after-the-fact permit as opposed to going through the normal town permitting process. The Plan Commission in their review has insured that the view from the river is preserved, no unsafe or unhealthful conditions have been created, that we have controlled water pollution, that we have addressed the location of the site in respect to floodplains, slope preservation zones and blufflines, that erosion was controlled at the site during installation, there was minimal impact on terrestrial and aquatic habitat, there is no impact in respect to future road and this was compatible with adjacent land uses. Seconded by J. Cuccia. Motion passed, all in favor. This letter is sent to fulfill the DNR notification requirement of the Town of Troy's Chapter 171: Lower St. Croix Riverway Zoning Ordinance. Sincerely, Sharon Provos Clerk/Treasurer Cc: Pam Quinn Brian Wert Peter & Nancy Zitzewitz Jim Thompson TOWN OF TROY Page 1 of 1 FOR TOWN USE ONLY Date Recd Notices Sent TOWN i TROY 654 Glover Road, Hudson, Wt 54016 Phone: (715) 425-2665 Fax: (715) 425-2551 Office Hours: Monday - Thursday 9:00 - 12:30 ST. CROIX RIVERWAY APPLICATION FORM FEE: $600.00 THIS COMPLETED APPLICATION FORM, ALL REQUIRED PAPERWORK AND FEES MUST BE RECEIVED BY THE TOWN CLERK, TOWN ENGINEER AND TOWN ATTORNEY NO LATER THAN THE 21 ST OF THE MONTH. (You will not be heard at the next Plan Commission meeting, but at the subsequent one). N0-F: REQUESTS TO CREATE MAJOR SUBDIVISIONS OF LAND IN THE RIVERWAY DPWRIC'T ARE ADDITIONALLY SUBJECT TO 77YE FEES, FILING SCHEDULE'S, DOCUMEN7A770N AND OTHER TOWN REQUIREMENTS FOR CREATING MAJOR SUBDIVISIONS ELSEWHERE IN THE TOWN. Applicant Information Property Owner: Engineer, surveyor ew or contractor n C,F ~~/'~,S L4 Et/a/usf~'enS~ ~•L.C, Mailing Address: _32.-R-4. Address: Ws" IA44 (.A - sdH u.) o Dyo Phone -3 2 Phone E-mail: E-mail: Site Information Street address p CO Legal address Section Town2 Ranged Parcel # Request For (check all applicable lines and indicate all types of permits requested) _1. Riverway building permit for only ordinary maintenance and repair: (Apply directly to the Town Building Inspector: Brian Wert Inspection Agency, 726E Highway 12, Hudson, Wi 54016. Ph. 715-386-5410) _2. Construction in a conforming area. 3. Sm-onstruction or expansion in a non-conforming area. A conditionally approved activity. _5. Variance(s) and conditional uses. On a separate sheet, describe in detail the nature of the requests checked above. Information Required 1. Unless previously waived by the Town Plan Commission, the applicant shall submit eight copies of all the supporting documentation required under the Town's rivetway and/or subdivision and road ordinances. (Provide a completed Sr. Croix Riverway Permit Application Checklist. 2. A list of all contiguous landowners or residents with unsealed, stamped envelopes addressed to these neighbors with a completed town notification form. 3. Also, provide copies of all materials, photos, plans and paperwork submitted to the Town to be mailed (at the applicant's expense) to the Town Engineer, WiDNR, St. Croix County and the Town Attorney at the following addresses: ~k (n n Cedar Corporation Rodli, Beskar, Boles & Krueger, S.C. Came Stoltz Ms ATTN: Russ Kiviniemi ATTN: Gwen Kuchevar WDNR St. Croix County Planning 604 Wilson Ave. 219 North Main Street 890 Spruce Street and Zoning Department Menomonie, WI 54751 P.O. Box 138 Baldwin, Wi 54002 1101 Carmichael Road Riv Fal , W[ 54022 Z ea Hudson, Wi 54016 Applicant's Signature: Date: - Z5. :2-wo http://townoftroy.org/Plan/Riverway_Application.htm 12/6/2010 Request: Filing & Grading, <10,000 sq. ft., outside Slope Preservation Zone within the Lower St. Croix Riverway District A ant: Peter & Nancy Zitzewitz 32KNorth Cove Road Hudson, WI 54016 Aunt James K. Thompson A.C.E. Soil & Site Evaluations, LLC 340 Paulson Lake Lane Osceola, WI 54020 Proiect Description: The site is located 328 North Cove Road, Gov't. lot 4, Sec. 13, T.28N., R.20W., Town of Troy, St. Croix County, WI., identified by the St. Croix County Real Property Listers Office as pcl. #040-1184-40-000. The parcel is bordered by the St. Croix River and bluff (>12% slopes) on its west side and North Cove Road to the east. The project included the replacement and abandoned of an existing hydraulically failed POWTS septic tank and drywell which were in a state of partial collapse. Due to the potential health and safety hazards present, St. Croix County and the Wisconsin Department of Natural Resources approved the immediate abandonment of the existing POWTS and the installation of a replacement holding tank. Abandonment of the existing septic tank and drywells was accomplished by removing all liquid waste and filling with compacted sand. A connection was made to the existing building sewer at 3'/2' below grade and was extended around the north side and paralleling the residence in a trench at 6' wide and 3'/z' - 6' deep. The trench then turned to the southeast and crossed beneath the existing asphalt driveway. Total trench length was 90'. A 3,000 gallon concrete holding tank was installed on the south side of the driveway, requiring an excavation of approximately 15' wide, 20' long and 10' deep. The total area of disturbance for the project was approximately 850 square feet, which falls below the 10,000 sq. ft. threshold required by the Town of Troy Riverway Ordinance permitting requirements. The holding tank is approximately 70' landward of the slope preservation zone and located on the opposite side of the residence. The floodway and floodplain are greater than 150' form the project area. There are no wetlands or drainage ravines present on the site. No trees or other substantial vegetation were removed to accommodate the installation. Ground cover in the area of the existing septic tank, drywells and the north side of the garage consisted of shredded wood mulch. The holding tank location was vegetated with grass and Fern/Hosta gardens. A twenty foot undisturbed vegetated area was left between the building sewer trench and the bluffline at its nearest point. All slopes within the proposed project area are negligible with slopes on the north side of the residence falling toward the bluffline at approximately 2 - 4%. Slopes are of an easterly aspect (away from the bluff line) at 1 - 2% on the east side of the residence. Topsoil was stripped immediately prior to construction of the POWTS and stockpiled adjacent to the system area. Excavating for material installation was completed immediately prior to, and closed immediately after installation of materials. Topsoil was replaced within 24 hours of project completion. The site was re-vegetated with Fern/Hosta/omamental plantings, seeding other areas with grass and placement of wood mulch over the remaining areas of disturbance. A EA-/-567 c,F'~tc-rQ~~. nsSa~eG✓ /~~~~'~C~~~eeJ,~~ elegy`. =/~o.a?' IAA 328/7o. doot yea! U~1 flc.~dsa~ c,J/. 5-yo/G 0 lob S~ P/aEo~a0rrx,-Aez /I cJf4/Sw~s~ mac. /3 T..2911., d~ywcJ/s. ~Q~~~~/~e.l. •rlo~o-//Bs/-4/o-~be%~c.7Grr.: EXist~~~ eway 33 s~ c.es.~Nd• enc~ r d~-Fn vs 7 ~o E,r,'s~' S&tl.5co-6L ~ fa:78 3 To 6e ab»ral osPer ~ baKtiee 6~ ri u.ie,ll Cc," n i 8 3.3 . be rrn.ov.d h~ 0 \'I 4j 0 9B /S, p fu4 re hea✓; (y c~codk/ ~ 4c AF S !o/>es y yeE~~~~ div e Sf: ma~-d ~ lc ^-50 to S ~vre/ K C i y. ~ o 60. ~'_ooe. Rcckd ~Ppfaxim" -;Z-o /C ~7fesei ~i1c, /0ca,,,-7o'n0+1 wLP3 GOV9aP. Aold n {~..iC• 40;5kbon%~ [3 u."ld.-, Sewer ~~dl 5~` res,du,ce / be.~ ca dr ✓e w a y a s rway Town of Troy Code - Section 171.I - General Standards in Rive 171 - C.LOWER ST. CROIX RIVERWAY RURAL RESIDENTIAL MANAGEMENT OVERLAY DISTRICT CREATED. The entire area to which this ordinance applies is hereby classified as a rural residential management zone as defined by Wis. Admin. Code Sec. NR 118.04(4). This is an overlay zoning district in that its regulations apply in addition to those found in the Town's Subdivision Ordinance and in the St. Croix County Zoning Ordinances. The requirements of this ordinance apply to all areas in the rural residential management zone within the Lower St. Croix Riverway in the Town and to no area in the Town outside of the rural residential management zone. The location and boundaries of this overlay zoning district are set forth on the zoning map, and that map is made a part of this ordinance by reference. An official copy of the zoning map, together with a copy of this ordinance, shall be kept at the office of the Town Clerk/Treasurer, available for public inspection during office hours. The boundaries of the zoning district and the zoning map follow the management zone boundaries established in Wis. Admin. Code, § NR 118.04 and cannot be changed without revision of NR 118.04. 171 - D.PERMITTED USES. 1. Single-family residential and accessory uses. 2. Conservancy 3. Forestry 4. Agriculture 5. Public parks, natural resource management and interpretation areas, waysides, rest areas and scenic overlooks. 171- E. PERMITTED STRUCTURES. The following structures require issuance of a Town riverway permit are allowed in the rural residential management overlay zoning district if the applicable standards in section I are met: 1. Single-family residences and accessory structures. 2. Piers or wharves that have required state and federal permits or that meet statutory criteria or administrative rule standards and do not require a state or federal permit. 3. Signs. 4. Structural erosion control measures constructed outside of slope preservation zones. Rock rip-rap may be allowed within a slope preservation zone and within the ordinary high water mark setback area if the Town determines that rip-rap is necessary to prevent erosion in flood prone areas and either a state permit is granted for the rip-rap or statutory criteria or administrative rule standards are met so that a state permit is not required for the rip-rap. 171- F. CONDITIONALLY PERMITTED STRUCTURES AND ACTIVITIES. The following activities and structures are conditionally permitted in the rural residential management zone district that require issuance of a Town riverway permit and that shall comply with the applicable requirements in sections I. and J. 1. Land divisions. 2. Planned cluster developments for single-family residences. 3. Transmission services. 4. Wireless communication service facilities. 5. Filling and grading within slope preservation zones. 6. Structural erosion control measures constructed in slope preservation zones. 7. Stairways. 8. Lifts. 9. Public roads and private roads serving 2 or more lots or single family residences. 171- G. CONDITIONAL USE PERMITS. Conditional use permits for the following uses must be approved and issued by the Town Board of Appeals. All such uses shall comply with the applicable requirements of sections I and K. 1. Bed and breakfast operations. 2. Home occupations. 3. Nature-oriented educational, non-profit facilities. 171- H. PROHIBITED USES. All uses and structures not listed herein as permitted uses, conditionally permitted structures and activities or conditional uses are prohibited in the rural residential management riverway zoning district. 171 - I. GENERAL STANDARDS. (Items 1- I1 are not included here) 12. Private On-Site Wastewater Treatment Systems. Private on-site wastewater treatment systems shall be constructed in accordance with the requirements of Commerce Chapter 83 or more strict requirements that may be required by the Town in its Subdivision Ordinance or by the County in its sanitation code. (Note: the Dept. of Commerce reviewed County Sanitary Ordinance and would not allow us to be more restrictive for certain regulations) See also Attorney Van Hollern's 2009 decision regarding county & town ordinances in the Riverway 171 - J. STANDARDS FOR CONDITIONALLY PERMITTED STRUCTURES AND ACTIVITIES 5. Filling and Grading Activities. (a) Filling and grading in any of the following areas are when the Town determines that all of the conditions in par. (b) have been satisfied: (1) In slope preservation zones that do not directly face the river and do not drain directly to the river. (2) Outside of slope preservation zones when more than 10,000 square feet of land is proposed to be disturbed by filling or grading activity. (3) Within 40 feet of a slope preservation zone. (b) Filling and grading in the areas described in par. (a) are conditionally permitted when the Town determines that all of the following conditions are met: (1) Filling and grading activities will not disturb more than 10,000 square feet of land that is located in a slope preservation zone. (2) No wetlands are filled or graded. (3) Any vegetation that is removed is replaced with native vegetation. (4) Filling and grading activities are designed and implemented in a manner that minimizes erosion, sedimentation, and impairment of fish and wildlife habitat. (5) The filling and grading is visually inconspicuous. (6) As part of an erosion control plan, Wisconsin Construction Site Erosion Technical Standards and Wisconsin Post-Construction Storm Water Technical Standards as included in the WiDNR Storm Water Management Standards must be implemented to control erosion. 171 - M. Administration 1. Riverway Permit (a) A riverway permit issued by the Town is required prior to undertaking or engaging in any uses, construction or activit authorized under the conditions and for the purposes set forth in sections and all of sections E., F. and L. of this ordinance, except for applications to perform ordinary maintenance and repair and where otherwise exempted. Applications for ordinary maintenance and repair that require a building permit shall be received and approved by the Town Building Inspector. Riverway permit applications are subject to primarily review by the Plan Commission. The Town Board takes action on riverway permits, acting only after receiving the recommendation of the Plan Commission. Other Town ordinances, including but not limited to the building code, road, driveway, utility and subdivision ordinances also apply in the rural residential mana ement zone, as do all a licable regulations of other governmental entities.