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HomeMy WebLinkAbout042-1086-90-400 g E 0 / R ; ■ - J % n E 2 ■ . T ® 2 � � 0 200 ° 7 , 3 co k � K, _ §�/ i� w> �jk # ° CO t . � CL , :3 � k CD \ §/t E E 4 J B E % 7 © / §/ ¢ ® ' \ ® 2 \ � CL / k a k k \ § � % "fti. z 0 0 0 § m § § § A § i E ■__ � K 2 co 7 !? E a) z 7 0 f $ % C 2N � w C. 3 E z 2 72 _ ■ ° > § z k } / z R E .. 2 « V § i E § / 2 § F @ 7 y 0) 2 ® � r- ;o = E£�=.3 -0 co § o §k c'$ ¥_c2) C coo(0— ƒ % §§ z , m.__ * &, 7 =�' o /k t ƒ 1 , �15 C. # 2 g} b a 3#�E ; i k 0 t / \ c E m =r M § E q� ■ o N � S: � a,2 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Dsion ' INSPECTION REPORT sanitary Permit No: 404979 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: Osburn, Alan I Warren Township 042- 1086 -90- CSTBM ev: ; (0�1 Ins� BMDescripti n: fah J �� /1 TANK INFORMATION ELEVATION DATA [ TYPE MANUFACTURER CAPACITY STATION BS HI FS EL V. Septic Benchmark 7 . a / 0 9.,9 /O a2 • G Dosing Alt BM Aeration Bldg. Sewer Holding St/H Inlet S i i, b I- / TANK SETBACK INFORMATION SVHtO let TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet �5 T q Nw Septic , 1 � / Z ! 7 Dt Bottom / I'rJ ►� s 02C ' Dosing H er /Man Q ' /0 -6 Aeration Dist. Pipe ° W' 8 . Holding Bot. System g • >D Final Grade 13 l -] • c PUMP /SIPHON INFORMATION r� I (L s - Manufacturer Den and S Cover t S1 3, 1605 1 1, Model Nu ber TDH Lift Friction s System Head T Ft Fo engt Dia. Dist. to well SOIL ABSORPTION SYSTEM y t q -1 /� BEDlTRENCH Width Length jNo. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 p g-� g 3 SETBACK SYSTEM TO l P/L BLDG WELL LAKE /STREAM LEACHING Ma?ctuv r j t . SLR INFORMATION Typ f System: ' 7 r2 ` ZDo (CHAMBER O i� CSC UNIT Model Number: DISTRIBUTION SYSTEM 2 /- Z. Z — 3 )QS+ W_ 5& Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake ✓ V I Pipes) �j Lla L Length "�ia �� Spacing � y- SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only cl� Depth Over Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center rench Edges Topsoil ; 71� . g p Yes No i Yes No KI COMME MTT (Incllude code discrepencies, persons present, etc.) Inspection #1: / fo / G 2 Inspection #2: T� Location: 627 91st S Roberts, WI 54023 (SW 1/4 SW 1/4 31 T29N R18W) NA Lot 10 �� Parcel No: 31.29.18.485Ak o 1. Alt BM Descri tion = '� `,_/ - KA G /J � 6- " C /� 2.) Bldg sewer length = 2 5 r (� 'L (O/ QG(IYI h � #, w,.. W iky -ikL-aA fs 0" Lo ` I - amount of cover = ti � ($ � rt,6 �' L O � � So ► l r-e�a ✓�S N�R,�c.e�/ Ga �� '�:� Plan revision Required? j Yes *� Use other side for additional information. % L_ -_ t✓� S y__ Date 1 K bA a e Qpcto�Signa a & e _ Carl. � SBD -6710 (R.3/97) (�.�c 5S �,�'( ommomm ��Nmm NN NEOEM MEMERi ■EM ■ ■ E■E ■ ■ 1 ■ ■OM■O■ONO /!Lrm /r■■ ■■M ■MMa M■■ MOMEME ME ME ON SEE M ■■■■■■■■ ■■mom ■■■■■■Gm■■■ `\ ■■■■■■■■■■■■■ EE■ NE■ ■ ■'� - SEEM mom ■ MOMME� ►_ MEMEMEMEMEMEMMO■ ■ MEMO ■■L ■!, ■ f ■ ■ ■ ■■ ■ NONE ■■■■■ ■ ■ ■■ ■ENE■ EEL"m ■ I ■■■■ ■■ ■■■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■2 mo ■ ■� 0 MHOMMEM MONOMER mom ME I ME MEN EMEMEMSMASSEVE ■ ■ IEnE■EENN ■■EONN ■ ■ ■ ■Em/En■Mon MEMEMEssu ME O ■ I �JO�1M ■Oil' /EE ■O ■mN ■■ ■[fir om ■■ VE am Am ■ I ■IE�iiiiiOEOE` saw- :il I111■IniE EOM■ 0 ■ MIKE 019111111 � ■ ■■ ■ Mons I■IINNINE ■ ■ ■ ■ ■ ■ ■ ■FA 1111 MOE■ON Mal ■i7�M! ■■■ ■■■■■ME /N IIIE■I!/M E■■i ■■ 11 ■EMOSSMtMdEO■■■■ OMEN ■ ■( ■ ■EE EE■ El NON ■■ 1 MIND ■%'�■■■■ ■■EE ■■■ ■ ■■ ■ODEON ■ ■■I MOO ■E /IiONE■ES ■ ■ ■EE ■��EO ■. I■■ I�i�1 E�1ON ■M�IEIII E OR, a ■ ■■ MEN ■O. 3lad ISO Mi li ■Eta[ _��■ �Y�/�iEE ■ENi ■ ■E■ ■N�IO 1 ■■■M ...�...!..��.. /■■ ■ ■ ■ ■ ■ ■ ■ ■ Elm ■ ■■ 114 S Lod t� `0© t d.A ( 3 Q3 Q� go 2- ook go; L.oT I P '"Tih o A _ i ,MAe4-) Safety and Buildings Division County /' 201 W. Washington Ave., P.O. Box 7162 r L C /27c Nvise n adi M Rz 537Q7 -7162 ite Address Department of Commerce O (�;__ Sanitary Permit ApPlic&ROIRECEIVED unitar Perot" m In accord with Comm 83.21, Wis. Adm. Code, personal info uation you provide �� Check if Revision n " may be used for secondary purposes Privacy Law, s 5.04(1)(m) 11. Application Information - Please Print All Information APR 0 1 2002 race Plan I.D. Number Property Owner's Name ST. CROIX COUNTY reel Number 31 , Z ,:k ZONING OFFICE Property / Owner's Mailing Address Property Location `J ?/T-_ N, R l� City, State Zip Code Phone Number Lot NumW Block Number 5lthdivisii n Name CSM Number bSb ('- "F. x/6 9 / 1I. Type of Building (Check all that apply.) n� �S �.: 13 city 4X 1 or 2 Family Dwelling - Number of Bedroom% e El Village • Public /Conunercial - Describe Use - rest Road • State Owned e Nearest Road III. Type of Permit: (Check only one box on line A. Numbering is for internal use.) (Complete line B, if applicable.) A. 1'M New 3 ❑Replacement of 6 ❑ Addition to S stem 2 Q Replacement System Tank Onl Existing S stem For County use B ' D Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of POWT System: (Check all that apply. Numbering is for internal use.) 44XNon - Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 5017 Constructed Wedand 22 ❑ Pressurized In- Ground 41 Holding Tank 48 0 Single Pass 51 ❑ Drip Line 45 0 Ai -Grade 46 DAerobic Treatment Unit 49 0 Recirculating 30 0Other a3, V. Dispersal/Treatment Area Information: 9 V l/ ll _ Design Flow (gpd) Dispersal Area Dispersal A,{ea Soil Application IVie6lation Rate System Elevation Final Grad Required Proposekl /' ) Rate(Gals. /Days/Sq.Ft.) (Min./Inch) Q 0 Elevation o 4f VI. Tank Info Capacity in Total Number Mhufacturer Prefab Site Steel Fiber Plastic Gallons Gallon of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attac plans. ~Plumber's Name (Print) Plumber's eure MP /MPRS Number Business Phone Number 'y 3� �( 7 ' Plumber's Address (Street, City, State, Zip Code) VIII. Count /De artment Use Onl Disapproved Date Issued Issu ng Agent Signature (No Stamps) Approved 0 Owner Given Initial Adverse Sanitary Permit Fee (includes Gr9µndwater \ Determination Surcharge Fee) �� C� 2 IX. Conditions of Approval/Reasons for Disap ral / �L( 5.¢c -� n ,,,�a� — b�. ►,nR.tD m P .°' ` �' � Cs�►�_ c�a / ozcQ.no�l(c�S . MBA( �Q �11� .� dt,� t� `� • - � Attach complete plans (to the County only) for the system on paper not less tW 3112 s 11 Imbes in size i I , k I , , 1 1 ,0 4 FT ­7qcl -�� U 1 i i I L J I _ Ll r I E f I ' , I � � , v , I , , ! I I - ' I ! j i 1 I i t - - -- , , I _ I 1 f I I {l jj r ii I ! i I ! I I ' I j I I I ; I I j J 1 1{ i 1 i i I j _ , , 1 I j f I I ' I I I i I I i I i - - - - - - - - - - - -t- -j- i I L7 i : : t f I I i i , i i : i I i I 4 _ I r, I. i ! 5 ! I I I j I , I f � f Wisconsin Department of Commerce SOIL EVALUATION REPORT pap i of 3 Division of Safety and Buildings M accordance with Comm 85, Wis. Adm. Code county St.Croix Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel LD // Q percent slope, scale or dimensions, north arrow, and location and distance to nearest road. L Please print all kdDanatlon. Re vie 4 Data Personal Information you provide may be used for secondary purposes (Privacy Lew. s. 15.04 (1) (m)). I C Property Owner Property location Harvey Hiclkema Govt lot NW 1/4 SW 1/4 S 31 T 1:1 �29 N R 18 )W Property Owner's Mailing Address L Block # Subd. Name or CSM# 540 Summit Circle 11 Hielkema City State Zip Code Phone Number Village ■ Town Nearest Road Baldwin 54002 7 5 - 684 - 2850 W ane n CTH N New Construction User Residential / Number of bedrooms 3-4 Code derived design flow rate 450 -600 GPD ® Replacement ® Public or commercial - Describe: Parent material T.nPCC nver nlrtwash flood Plain elevation if applicable NA it General comments Site suitable for a below grade conventional sys RECE' V and recommendations: A4AR 1 2 0 Boring Z. CRO /x 1 Boring # ® Pit Ground surface elev. 99.75 ft. Depth to limiting factor >11 ZON /NG OU 7 Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 3 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 I *Eff#2 1 0-18 10yr3/3 - Is lvfgr ml cs 2f .7 1.2 2 18 -36 7.5w5/8 Is lvfgr ml cs if ,7 1.2 3 36-110 7.5yr6/6 s Osg ml _ _ .7 1.2 2 Boring # ®Boring 96.47 >110 El Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1f1? In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *E11#1 I "Etf#2 1 0 -17 10yr3/3 is lvfgr ml cs 2f .7 1.2 2 17 -37 7.5 5/8 - Is lyfor ml cs if .7 1.2 3 37 -110 7.5yr6/6 s Osg ml _ _ .7 1.2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 150 mg/L ` Effluent #2 = BOD mg/L and TSS 5 30 mg/L CST Name (Please Print) Signature — CST Number Thomas C. Nelson 227387 Address Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond Wl 9 -11 -01 715 -246 -2454 p�, Hielke 2 3 P Owner !D i! off+!. Of n Boring iii Boring # [' pii r... sm fia ce Wee. %.22 u i-h 4 fa�±sx X110 ;,, I S Appk- P I Horizon Depth Dominant Color Redox Description Todlre Structure C;onsistence Bo iffy Roots GPDlttt in. Mansell Qu. Sz. Conk Color Gr. Sz- Sh. 'Etl#1 'EB#2 1 0 -30 10yr2 /1 - IS lvgr ail CS if .7 1.2 2 30 -60 10 3/4 - is lvfgr ml cS - .7 1.2 3 60-110 7.5yr&6 - S OSg ml - - .7 1.2 ' Owi ng # PA C=rs.'' n-- elm P ,,,r'^'r't M t : arnJiti ;, tb—ctM h w„ •_ I Horizon Deplh Dominant Color Redox Description Texture Struchxe Consi Botridety Roofs GPD11l= in. Wnsell Ou. SL Cont. Color Gr. Sr- Sh. TIM T02 -- T F n # Baring p Ground arrfaoe elev. __ ft Depth !0 frtnlUng fat#Or r1. .. - I Ja -- - 1 /Rat. Horizon Depth DorrdnantCdor Redox Description TeA" Siruct re Consistence Boxxiary Roots GPD/(e in, Mansell QJ. Sz, Con* Color Gr, Sz Sh. *F-#" *E# N2 Muent #1 = BOD > M <2W rng!1. and M >30 :s 150 rng& ' Mient Q = BOD < 30 rrg!L aM Ta < 3t1 ffg& The Minat rent 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- 2644777. 1� �rz�e N ►�l ke y, �. Y r) t/� S w �� S 3 I T Z Gi N 1 LJ LJ ry) Q0 3 q ;12- E �B ��1 �s Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. zFft percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 0 Pf Please print all information Reviewed by Date 2, y� Personal information you provide may be used for secondary pure v cY Lr, 5.04 (1) (m)). Property Owner ; �� - rop Location a � V pe y Govt:: Le W 1/4 ,sl f 1/4 S J/ T .Z 9 N R E (or) W Property Owner's Mailing Address I zS Lot # ocic # I Subd. Name or CSM# syo Sl�•�i.�l / T-- G/ c L - / f•' .�Q /Nc- G s rt City , State Zip Code Ph ~ umb - , City ❑ Village own Nearest Road ,ST: /,f-� 41/. 5Y gy T 5F3,ec s _ New Construction Use: W Residential / Number ms derived design flow rate t9 GPD ❑ Replacement ❑ Public or commercial - 4 _ �a4- Parent material ' " Mood Plain elevation if applicable ft. General comments $,� P! • 3 foie S�E /•c ��U�S lD,� and recommendations: d F -/1 Boring # ❑ Boring p US 2 S $S• 5 . Pit Ground surface elev. // ` 77 ft. Depth to limiting factor in. Soli Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 0•/3 /oY 3 /3 — L / >N W Z .14 Z 13-11 io YR 31 — SQL / SAe /he A i' CS . z .3 3 /f • 2-5 10YR SQL Z 41 dk 7 --,- ' CS — . Y .61 /D YR GIZ. Boring # E] Boring ll�T Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 2 qi • & log 31Y -- SL 17 W iw, Yee 11 • y • Co 3 16 2 /D e 6 — SL /7 X /h,�/ �•SYe c2 Ho 70W q/ Y A 31 ' Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 _< 150 mg /L " Effluent #2 = BqP, < 30 /L and TSS < 30 tng/L CST Name (Please Print) Signature CST Number R o f3 e Z/G$�P� GG,T 2 2 -4 .3 - 73 7 Address Date Evaluation Conducted Telephone Number 71S • 3A6 • �i�S Utbricht & Associates Private Sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54016 r Property Owner E� �G M/! Parcel ID # � Page 2— of 3 Boring # ❑ Boring QZ • / y Zp S -Y . �- Pit Ground surface elev. / ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Descriptign Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu: Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 i9'/f( 1 1OW313 c I-I S bk f e w 1 f . . c, l N 100 3/ Sic. /fS k �i ' c — . Z 3 •Z& /O / g /y SSG Z 11W .tL -64 7. S V9 c 2 a2 H OTS SL /oYX (W sye F-1 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 /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 F71- F F-1 Boring # [] Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color h. •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 -8330 (A.6/00) ���• `es is t Psgoe \G V1b <« a Se�s9 ess 0 - 54o1g c 655 co �1ts• 1 7 L Nub y Z[.c3 }'l D s ys I • � - �AL��e it w b / LO r To p F 3 5f q1. 30 ' �z 4 r � � Zy' y D .7 9' s o : DoT - �o s 11,,,E laa C2 J - �+• -'F8 eswl q8s(3 –lp 65645$ Q� KATHLEEN H. WALSH ST. CROIX Co. wi p E.o`h 9 C S 0, ' c Nlk 9 RECEIVED FOR RECdRRD 0 � 09 -12 -2001 1:45 PM COPY FEE: 4.00 RECORDING FEE: 15.00 L** c� C SW wtv4 —� —yD ifiecl u ey Map Harvey a Part of the Southwest 114 of the Southwest 114 and the Northwest 114 of the Southwest 114 of Sectio 31_ Tow nship 29 North, Range 18 West, Town of Warren, St. Croix County, Wisconsin, being Lot 4 of that CertifiedSurvey Map Owner's Address: worded in Vol. 10, Page 2924 of St. Croix County Certified Survey Maps. 540 Summit Circle Baldwin, WI 54002 LOrl, S. M., VOL.2 — I C. S•% VOL 6 PAGE 1,580 i I r PAG 492 1 Lo LO T 2 1 LO TS — � 3 "' PR 1 VAJrL20 Q I _ / I S 89.00' /90.00' _ 704.06' I _ /00 J /00 ri oo ,- O i^ —/ 0 I AREA • „ Q I =W ^ Lore z ,, ,sue `� �;, g o a N �p 2.8 18 ACRES ^� �, J • b 122,735 0 V / L o T 9 v/ So. FT 'M b v p 0 I i�.9654C OT. /{ n w N I a I O 2 ` N 6 �i 434,090 SF b N NI y 1 - 9.666 ACRES EXC. ROAD/ ic F 74.19' y b �hM1 [�j R/GNr OF WAY LQ..AR� 41 A O�ti •h1.y4 42/, 031 SO. Fr. ` — v "� 1 V J I s 1 J SO /L BORING R ' 4 i ti �I 3 \ 0 0 � rrrv.) 1722.25• '�� � „ ♦ � �+ �• S B9 • 28'34 "W ?37.71' �I W • Q �� 4 b O ry A`Y ig ROAD AREA 08' in 0.789 ACRES 34,36 1 SO. Fr. a• s CL v 0" 1 © 2. Fos ACRES CX I 87,344 so. Fr. M h O N 3b '�-° m I j N89 "E &4 7.7/'„ i� —�� AJ q S LINE SW I14 O 2 JI I I O i D r" ^ O O 1351.47' R 11349.62) /2 Q im Of m 0 \0� I • I \ 2. 027 ACRES N — I I N *8 'E 2664.81' R/NBB •54'5 ? "E 266 /.?/') I BB, 3/5 So. FT. — SW CDR. SECT /ON 3/, r29N, R18W, S 114 CORNER OF SECT /oN 3/, 17 O /?" IRON PIPE FOUND/ T 29N, R 18 W ' , /BERNTSEN NI I S &9.28'54 "W 354.19' ALUM /NUM CAP FOUND) 1 3 3 33' l 66, I L O r 7, - C - l M ., VO L. /0, uyuwwlw 3� JI �' PAG 2924 ��eJG0 111,��� �Z APPROX. PROPOSED DRIVEWAY LOCATION ALL BEARINGS REFERENCED TO rNE SOUTH LINE W . wi OF rNE SOU rN WES r 114 OF SECTION 3/, S 1713 ASSUMED NBB•42'04 "E RIVER SCALE /".- 200' O 50' /00' ?00' 300' 400' 300' Dated: September 5 2000 Sheet 1 of 3 This instument drafted by Laurence W. Murphy Vol. 15 Page 4169 i LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF WARREN COMPUTER NUMBER 042 - 1086 -90 -400 Parcg6Number 31.29.18.485A -40 OWNER NAME: First A Last OSBUR PROPERTY ADD ESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment (p 0 11191 ST ST SECTI N 31 TOWN 29N RANGE 18W '/.160 NW '/.40 SW Line Description Line Description TOTAL ACREAGE 2.027 PLAT CSM 15/4169 FKA 10/2924 042/01 LOT11 BLK 01 SEC 31 T29N R18W PT SW SW & 15 02 PT NW SW BEING LOT 4 CSM 16 03 10/292417 1 604 AC 04 CSM 15/419 LOT 11 18 05 2.027AC 06 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1- General, F4 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, F8- History, F10 -Exit 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 pemrdts 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 Des n Specifications Santa Permit Number 7" Number of Bedrooms Design Flow - Peak ( pd ) Off*' a0 Estimated Flow - Average ) O Septic Tank Capacity (gal) f Soil Absorption Com onent Size ( ) - — P-•< 6, Type of Wastewater Domestic Table 2: Soil Abs Ion Component - Limits of Reliable on Septic Tank Component Soil Abso "on Com ent Design Flow - Peak /� r Maximum Influent Particle Size (in 1/ Maximum BOD /L 220 Maximum TSS (mg/L 150 Table 3: Maintenance Schedule Septic Tank Inspect and/or service once eve 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 Tgnk 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. Th outlet filte shall be cleaned as neoessary to ensue proper operation. The filter cartridge should not be removed unless provisions are made to reta n so ; ds in the tank that may slough off the filter when removed from its enclosure. If the 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 septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 113 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 covets 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 fallure must be replaced. Exposed access openings greater than 84nches 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. ST CROIX COUNTY fEPTFIANK MAINTENANCE AGREEMENT AND ' RSH CERTIFICATION FORM Owner/Buyer Mailing Address , Property Addr "� T a � ;,,t` a,�� r ro (Verification required from Pla g t for new construction) L e Cigatate �b +ti's 0 1 ' a. d t Parcel Identification Number 0 W ( O� P LEGAL DESCRIPTION ) Property Location -S ;, ` /,, Sec. 3 . T — LN -R, l E W, Town of Subdivision Lot CertiCe;d Survey Map # - G ` . . Volume S . Page # � ±' Warranty Deed # (o7 � j t . Volume ��' Page # Spec house 0 yes 0, no Lot lines identifiable yes 0 no SYSTEM MAINTENANCE ImpwWuse and maintenanceof yourseptic system could malt is itsp n lmmfaffuretohandlcwasteLPropernnfidwanoc consists of pumping out the septic tank every throe years "sooner, if necdod by a licensed pumper. What you part into die system an affect die function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to SL Croix Zoning Department nt a catification form, signed by dw owner and by a masterp][umberjourneyman,plumber, resbactodphanberor a hcensodpunrper verifying that (1) dme on -site wastewaterdisposal system is in proper operating condition and/or (2) afterinspectioa and pumping (if necessary), the septic tank is less than 113 full of sludge. Uwe, due undersigned have read tie above required and agree to naiatain the private sewage disposal system with the standards set forth, berein, as set by die Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certifleation stating that your septic system bas been maintained must be completed and rcdunod to the St. Croix County Zoning Office within 30 days of dudiree year expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner($) of die property descdbod above, by virtue of a warranty deed recorded in Register of Deeds Office. 7 66 - NATUO OF APPLICANT DATE « « «sss Any information that is mis-n prescuted may result in the sanitary permit being revoked by the Zoning Department. ssss «s «s 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 Management Plan for a Sap1ic Tank and Soil Absorption Component I over or within ten feet of the Plantings of deep-rooted troes and shrubs directly component should be avoided since root intrusion into the component may obstruct wastewater flow. 3 CON'T'INGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to Provide a code comp0ant replacement system: A suitable replacement area has been evaluated and may be utilized foc the l ocation ola replace Yic e absorption system. The replacement area should be protected from dlstueWnce and cornpaCtlon and shotfib rot b be InMt�ed upon Dy required setbacks from exhung and proposed strVCWre, lot lines and wells. Fallure to protect tM replacement area will result in the need for a new soil and site evaluation to establish a sultabie replacement area. Replacement systems must comply with the rules In effect at that time. O A sulUble replacement area b not available due to setback and /or soli Timladons. Bartinif adva Ms in POWTS technology a holding tank may be lrntulled as a last resort to replace the faked POWTS- * The site has not been evaluated to identify a sultabie replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a sultable replacement xea. If no mplacement area Is avallable a holding tank may be Installed as a last resort to replace the failed POWTS. D Mound and at -grade soil absorption systems may be reconstucud In place following removal of the biomat at the Infnuative surface. Iteconstructtons of such systems must.cornply with the rules In effect at that dme. < < 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. RESCUt OF A PERSON FROM THE INT9RIOR OF A TANK MAY EE DIFFICULT OR IMPnIVE1101 F. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name o Name Phone Phone SEP'TAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Narnef ' APncy S C ro ' fir- - U 1860P 399 6745�Z STATE BAR OF WISCONSIN FORM 2 — 1982 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX co MI DOCUMENT NO. 'I RECEIVED FOR RECORD Harvey 11. Hielkema and Suzanna H. Hielkema 03 - 26 - 2002 8 :25 AN u s a n a n wif WARWMTN DEED EXEMPT # I! REC FEE: 11.00 j conveys and warrants to TRANS FEE: 246.00 Alan C. Osburn and Joan M. Osburn husband COPY FEE: i) CERT COPY FEE: and wife PAGES: 1 i �i i; I THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS the following described real estate in St.. Croix County, State of Wisconsin: 1 to OA /l) 042- 1086 -90 PARCEL IDENTIFICATION NUMBER Part of SW 1/4 of SW 1/4 and part of P1W 1/4 of SW 1/4 of section 31, Township 29 North, Range 18 West, St. Croix County, Wisconsin Described As Follows. Lot 10 and(f1 Dof Certified Survey Map Filed September 12, 2001 in Vol. , age , DOC. NO 656458. l i i i i' This i s not homestead property. (is not) I Exception to warranties: I !I Dated this 22nd day of March A *X 002 (SEAL) (SEAL) „ Ila va 11. Hie kema (SEAL) (SEAL) . Su nna H. Hielkema i i AUTHENTICATION ACKNOWLEDGMENT State of Wisconsin, Signature(s) ss. -- St. Croix County, authenticated this day of 19 Personally came before me this 22nd day of March , 2002 , the above named Harvey N. Hielkema and TITLE: MEMBER STATE BAR OF WISCONSIN Suzanna H. Hielkema (If not, authorized by §706.06, Wis. Scats.) to me k e own to be the person who executed the foregoing ,,�luni►Ip „� iristru nt and acknowledge same. THIS INSTRUMENT WAS DRAFTED BY 6 'J Ral�/� y '��i HnrvP�r N Hi P1 kPmn 'n Bec Rasm Notary Public, $t Creix County, Wis. (Signatures may be authenticated or acknowledged. t M s . My commission is per�tanent. (If not, state expiration date: necessary.) p t 12/ 15 / 2002 19 ) _` Names of persons signing in any capacity should be typed or printed belo S 'WISCONSIN Wisconsin Legal Blanc. ARRANTY DEED Form o. 2-1982 M"auke� 656458 Y,ii l'HLEEN H. WALSH REGISTER OF DEEDS 81. CROIX CO. WI RECEIVED FOR RECdRD 09 -12 -2001 1:45 PM COPY FEE: 4.00 RECORDING FEE: 15.00 Certified Survey Map Harvey and Suzanna Hlelkema Part of the Southwest 114 of the Southwest 114 and the Northwest 114 of the Southwest 114 of Section 31, Township 29 North, Range 18 West, Town of Warren, St. Croix County, Wisconsin, being Lot 4 of that Certified Survey Map Owner's Address: recorded In Vol. 10, Page 2924 of St. Croix County Certified Survey Maps. 540 Summit Circle Baldwin, WI 54002 LOT M, VOL .2, C--S M r VOL 6, PAGE 1580 PA6E I LOT / LOT 2 j LOTS = ►-- - _I_ I -- M a I b 589.00'03 "E 9 / 3 . 71 'R/9/ ?.76'/ 3I \\ `` /90.00 i. 708.06• W 1. - q 723.74' /9,B '+ �I \ i J /00 W h\ q i '1/ i l I O1 ^I W V' t ,I / LOW gREA ,�� r V, r h I Q Lore ~ 'j 2.818 4C.TES N ^� 11 O 11 /22.733 e ♦' / L o T 9, I,(;' ✓� O so. FT. V O i 6 4J4, 090 SC.,- b IN Q N23 5 YY'E- 0 3 4CRES £X C. R040/ \` V7 w 78. O.4 \�\ R/GNr OF W4Y LQG✓= REJCD v :� 1 S S A a v N ♦ 1 b 4?/, 03/ SO. Fr. '� . W # °• g M W� V SO /L BOR /NO '' i ` I n V 3 / 6 'O6',. I J y t7)10.1 '!!.v 2 �I ♦ �O 'sW 1� 0 22.25' E 08 OI 4 QO `L 7. S 09•?8'S4 "W 557.78' 0zI 7 � C� v ° o o �DO�p,♦ 4 y � 1 �"' , ROAD AREA 6p\ � � y / N ` at ' , J / O /�' OO hI 0.789 ACRES Y ww X ri $ V 31,36/ SO. ir. a ' g CL °o I £ 3 E L T �0 0l I LLJ CL '!© 1.905 ACREf h N h J O H b 3 Q y F' Cn 87, J44 so.Fr. N4 3b c g I f N89• ?I'S V 647. 71 u h 1�I (� � r 7 r �• h'° i CL S LINE SW //♦ o f o 11 Iy_ , of /311. 87'R //J 49.6 2' 1 WI • I ` 10 ?7ACR h _ V N 88.41'04 '£ ?664.65' R /NIB •54'92 "E 266/.2/'/ a /5 So. T, SW COR. SECT /ONJ /, r19N, R /BW, S114 CORNER OF SEC r /ON J/, v _ " N P /PE FOUND/ r 29N, Or low, /BERNrSEN B9• 28'54'W 354. /9' v- 4LUM 11VUN CAP FOUNDI p ( I 1 I L O T 7, C . S_M., VOL . /O, , � PAGE 2924 �O1Ya�� APPROX. PROPOSED oR/YEWAY LOCO r /ON �I ALL BEARINGS REFERENCED TO rN£ SOUTN LINE W of rN£ sou rNWEST 114 OF SECr/ON J/, 81713 4 SSUNEp NOS RIVER FA11.8 SCALE / "r 200• WI O 5o' 100' 200• 300' 400' 500' Dated: September 5 , 2000 Sheet 1 of 3 This insturrent drafted by Laurence W. Murphy Vol. 15 Page 4169