HomeMy WebLinkAbout010-1024-10-050 (3)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes (Privacy Law s.15.04 (1)(m))
Permit Holder's Name City Village Township
DENNIS & DORIS BERENDS TOWN OF EMERALD
CST BM Elev Insp. BM Elev. BM Description.
TANK INFORMATION ELEVATION DATA
TYPE
MANUFACTURER
CAPACITY
Septic
V t(1twv--
6/u/fft)—
Dosing
, ar��
Aera
Holding
TANK SETBACK INFORMATION
TANK TO
P/L
WELL
BLDG.
Vent to Air Intake
ROAD
Septic
sot
Dosing
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer
(,
(�f Jv) 1
Demand 01
GPM
Model Number
� N
TDH
Lift
`? °off
Friction Loss
Hs
System Head
3r3
TDH Ft
11 39
Forcemain
Length p'
Z
IDia-
��
Dist. to Well
� So
SOIL ABSORPTION SYSTEM
-, n'. St. Croix
Sanitary Permit No:
648407
State Plan ID No
Tax No:
010-1024-10-050
JTownlRange/Map No.
10.30.16.150A
STATION
BS
HI
FS
ELEV.
Benchmark
r�l��
/
a�,o
Alt. BM
Bldg. Sewer
la
SUM Inlet
SUHt Outlet
/
Dt Inlet
DtBL&Num
Header/Man.
3 �/
Dist. Pipe
�qy�n
06.) 4
Bot. System
Final Grade
S!-;/�Yl�ri V-Vgrd
L.0�1,t�
r�
�-�
� �
��•Or
BED
Width
Length
No. Of Trenches
PIT DIMENSIONS
No Of Pits
Inside Dia
Liquid Depth
NSIONS
�,
SETBACK
SYSTEM TO
PIL
BLDG
WELL
LAKE/STREAM
LEACHING
Manufacturer.
INFORMATION
CHAMBER OR
Type Of System:
�r- / I /
1 Al
Model Number
UNIT
DISTRIBUTION SYSTEM
HeaderlMandold
Length
Dia
Distribution
Pipe(s) (
Length % Z Do
�' Spacing
x Hole Size
-3
x Hole Spacing
I
Vent to Air Intake
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over
Depth Over
xx Depth of
xx Seeded Sodded
Mulched
Bed/Trench Center
BedlTrench Edges
Topsoil
Yes No
jxx
Yes No
COMMENTS; (Include code discrepancies. persons presentt,,,etc.) I Inspection #1: F' ! I l 2 CD 3 Inspectior #2.
Location: 2469 160TH AVE CCTV G � C V` DJV4 A—
1.) Alt BM Description = Z t a>7 1N fiF "A `Cd )aAtr� v- iA
2.) Bldg sewer length s vb*e laud
- amount of cover = ''li• t Sbi l t 0114 bu i\j f v�
Plan revision Required? . Yes x No
Use other side for additional information.
SBD-6710 (R.3!97)
7[
23
�,�Tb�I�q
Y
Date
r gnature Cart No
FR-��FTi�Ii��
2.A
20 3
4WU@&an Y„,& w,%EC E I V
I s
N. oa� S137
S�, P it Nw obw (ta be OM by Cn)
IP
St. crorx Covr
P.O162
MadbMW1s37,16JE8 0 7 2
L.
5hCafiOn ST. CROIX cols:
Ts�oboaNt'd'a
Is aeaoe bow wigs SPx 383.211 arm Adm Cedem6missioa of tiffs bms b dw sppeoI iam goveramsatal aeeit
wTs — I
Is taget W P W ID a =may Paima NOW AnOmn brass ix st *l -wow POD ate subm ed to
fW DWwft t of 9sbty sod Aairaasl 8wsioa Pittaaasl iabe'edw you psoeede aaq be wed Ix na nday
Pmjea Ad&m (ddiMate•t rues mm is ad*mu)
purp�fn-eeadteoe w% dw Iaw a 13 &rate
awls
Propmly Ohs N 0,
Feel
r1
EvviS f �A.t +S ICOCIf
O/Q
Nwwy Q°" rues A&bmn
P ."aty L mthes
P114 Ito AfE
cOVE. Lot
City Stets
Zip Code
Phone Number
45'iyE .41Q W X
SyO 13
-51dy, .56 y, seem /O
T 30 iy R L
IL Type of BdIdbg (dwek as the app W
Lot s
101 or 2 Fsn Vy T — Number ofBadtooms 3
r
sabdieioan Dame
�uMiolCa�l — Dest�e Ilse
ex Grt
Bbck f
d
d
Owned — D==ft Use
CSbI Neaesbr
rSE
own of Ei'r E,r�r L 0
QL
Ily" of POW S (am* d&w ar "RSOMMahme OW Obw appbmbb.a:ae A. Omxk tas box in sme s. Cnapltla IW C ff
A.
Sysba
$yateea
[106. idoddicadon eD Rdoft Symm (egb a)
Adltmd Pmmetmeut Ih* (.qjw.)
B.
�Fioiding Tsstk
�{
X lNmmd Z
Lediv Sias DswipP
Type (�)
C•
$eoowd Be A.
Fsgitatioo
Ravisioe
of Fte enber
[DT`am t to Plaw
Previous Ptivatit
N•
Arta awii Tw& iafitrws&a. C
w&t Flow
OMP Soil Application EetW(li &"
Ditpetael mm Ragtited (sty
Disperasl Area llaPwsd
YSo
I.O
!/��c
7J�
7 `
HSO /. S Od 474 CO,+s'Oa,e
cipwify
TOW
#of
M
Z� bilma x6m
l9aliowm
Clsllcas
Taairs
T` T� �'
V
v
y3n�
Now
7titf�
310
i
Q
4
Vl
p
Sam
/.?d0
—
/%a0
LaJ/fSE� �al[,e[rE
Detieacr.drr
�3ao
--
80a
1
1Co.•rd
V. Raepoesa 3tatas t>re wibMped, aea..e r.*..,�ty br M trs atiswa an -.weber peww.
Pitaaber's Name (Pft) Plumber's /Wfts su"eteee Pbom )k"W
Krwr �oxE
aj y1 ? 9 71S- W Z - 811SS
PlwnWs Address (Shoat Cay. S>gc� TP Co&)
,pa " 400WXJ 7ao
vL
Amm wd
17
PbefmttjF�es
FGe
Uess 6sased
Aleet SVtettsR
O
t
`
wa iiaaaso D,"
eo
3 Z
Conditions
3} sS
SYSTEM OWNER:
3eptic tank, filter dispersal
effluent and cell 4) �� DS S tM
must be serviced 1 maintained as re
nagement plan provided by plumber. 4— .
I setback requirements must be maintained
nee nor nnnlirna
�--�- •.. �. �.� w.� w �Le�q eat w P*W neaten waf a wax el sages ■ st e
SBD-O" (R. 6321)
Opt
I1
Cl%
(
o,
v
d
W
�
3t
AO
�1
_a
o-
�O
r
O-
f
cr
N
L
V
/
3
L
y�o
b
4 W
t. y
t
V
Wisconsin DePartrnenl of Safety and Professional Services
Division orindustry Services
4922 Madison Y" Way
PO E dx 7302
Madison, WI 53707
December 6, 2022
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 2024-12-6
Plan Review: PWTS-122202887-C
Kent Hoke
200 Bremer Ave, Ste D
Colfax, WI
SITE:
Berends
2468 160" Ave
Town of Emerald
St Croix County
SW Y, SE %, S10- T30N — R16W
FOR:
Description:3 bedroom-450 GPD mound-35"
to limiting factor- Effluent Filter -
Maintenance required.
Phone;608-266-2112
Web: hM.' d,p�.wV',kl%
Email• ds .i u ibconsin o_
Tony Evers, Governor
Dtrn Hereth, Secretary
Conditionaiiy
APPROVED
DEPT. OF SAFETY AND PROFESSIONAL
SERVICES
DIVISION OF INDUSTRY SERVICES
6,r..�.
SEE CORRESPONDENCE
Mound Component Manual — Ver. 2.1, SBD-
10691-P(5/22-5/27)
Pressure Distribution Component Manual — Ver.
2.1 (May 2022-2027)
Verify proper dose is achleved -and is not being over dosed.
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative
Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be
constructed and located in accordance with the enclosed approved plans and with any component manual(s)
referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance
with all code requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per
s.145.06, stats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
Reminders
• The site shall be properly prepared prior to plowing. Any grasses longer than 6" shall be cut short and
removed. To avoid matting, any leaves or loose organic matter shall be raked up and removed. Cut trees
and shrubs flush to the ground and leave stumps. Avoid operating equipment on the
Mound site. If necessary, use only tracked equipment, during dry conditions, with minimal passes, to avoid
compaction.
• Components and soil removed from an existing drain field shall be properly disposed of so that there is no
risk to public or environmental health.
• A sanitary permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.19, Wis. Stats.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made
with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis.
Stats.
• A state approved effluent filter is required. Maintenance information must be given to the owner of the tank
explaining that periodic cleaning of the filter is required.
• A copV of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors.
Owner Responsibilities
The current owner, and each subsequent owner, shall receive a copy of this letter. Owners shall also receive a
copy of the appropriate operation and maintenance manual(s) and be responsible for ensuring that POWTS is
operated and maintained in accordance with this chapter and the approved management plan under s. SPS
383.54(1).
In the event this soil absorption system or any of its component parts malfunctions so as to create a health
hazard, the property owner must follow the contingency plan as described in the approved plans.
• The owner is responsible for submitting a maintenance verification report acceptable to the county for
maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s)
utilized in the POWTS.
In granting this approval the Division of Industry Services reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the
address on this letterhead.
The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and
any others who are responsible for the installation, operation or maintenance of the POWTS.
Sincerely,
"Tolha4w ITOWZ y
Joshua Rowley
POWTS Plan Reviewer, Division of Industry Services
(715) 634-5124
Joshua.rowley@wisconsin.gov
Private Onsite wastewater Treatment System
Index and Title Page Y iYl Page .� of 9
Project Name: NVNI
Zof
ou�3 CR! LAtl�rlivr�
Owner's Name: /e �
Qa,trs E�r..+a
Owner's Add:
E E���v GJI i'o/j
Legal Description:
Municipality:
Town, VA&$e, City of E.erE.c��Q
County:
Lot Number.
----- Block Number ------�
CSM Number -
Subdivision Name:
y� g ,O
Conditionally
Paroel I.D. Number
O _ D - D aDERI-OL'I&EETYAND
PROFESSIONAL
pw 1
Index and Tttk page DIVISION OF INDUSTRY SERVICES
Page 2
Plot Plan
Page 3
Cross -Section & Plan View
�- A
Page 4
PiPC Lateral 1.ayuut
Page 3
Septic Tank / PUMP Chamber Crow Section & Specific-i ORRESPONDENCE
Page 6
Pump Performs= Information
Page 7
POWTS Owner's Manual dt Management Plan
Page ii
POW'I'S Owner's Manual & Management PIn
Page 9
Ater Wormafion
Name of Designer
r a aE License #:
- .2Jy/ 99
Signature;
Date:
"Mound
Pressure D'
Manual for POWTs- VaEdon 2.1 (May 2p22-
-
on ComPonent Mwad liar POVn ;S" Version 2.1 May
Atrachmenr Sol] Evaluation Report
027)
�•
L
? v
a
V
It
h10
Wic
rqlip,
}
r
h
i
K
h
q
I
a
v
V
b
'
a
�x
�
y
O-
O
im
AT.
0
J
LL
n a
I
w
an
O
44 w w
U tl II N
W
I a
IE
LL
m
as
0
�- r
�00 Y
1
4r�f �•`
a
•
•
!' �'
cc
VI
0
�
O
LL
O
`ti
''
•'ti
x
CY
.;
CLI
m
�r
.ti.
� �
�•G
'I
X
p
fl
3
_N
w
w
w
4W
w
4W
w
11
it
it
II
11
II
a
a
av
H
h
x
a�
E,
ef c J
y I In In
0
rv�
v0 jsq 'Q!P .8!£ jo 'JelIM
;asor Agp-Wm adyd
Paps ' MOD Z3 �
_ r
t1�
❑
a
•o
w
a
N. -_ ll.M.. ���1 _1�,i'�.<- '-a�'• .;t�L =.�' Ala
MMlIOLE b WVER
4,w.S4L/0RIc%*ww
MaawtM of r of SIffTAB,E e®oM SBCATM TAW i - - ... O .
Anq,�,0 dd„k m r tie N*Amd Waft BURY a6'TM OF �
Tank Ulanufactrser /E ,t c csrf
S+epwNmp Sim MUM NM*w.
TYM
Bmwnt Pump Baer: L rn
dr Model Number. 9 Ec r
Wftum Dieci=W Raba .?S, og (3Plbt
Vertical UR 4UM off to Q
ft
SYatsrn head (di" � _eL x 1.3 ff): 3` ft
. a7S R Some mein x BOO friction lackm�� R
Fferfrictbn loss ................... _ _
Total pynamlc Flasd ii oFn� L
Daly Wsalaealar Flow (DYVF): So GPD
Number of daffy
�_ tt z _ . !13 O�tIR � !
Amdose rod dww qa. S
(� doss vo�ne - vo his = 85! _ Ow 9M
maim-WAMM.
ReseM sbaua alam 0.1 h = 3 Y 3 9s1 (D)
Alarm &M aborts on Bost _�_ in - 3 s gl (C)
On/Off > 5 Y in = 9D. S 9W (B)
Off above tank bottom _ $ _. In- /3f I
Lango 1S0 in
O-umt twWx 9 i in
Wkkh BY in
G"wM& /��
l')
Page �- of q
POW IM Uwmm'g MANUAL AND MANAGKKCN'T PLAN
FILfi MOR"" Il
Permit
UMM WAttAt+ W..
On,
:ls
soil OWN60n Rsoe
Wueat(Etiltt O Qm ty (0 NA)
fly Avmwp
Pant. On t naase (FOq
Biocbcn*d q4'W Demmd (BOW
< 30
Toot &N* ailed SoftCrM
S no'
� ISO �
Pwd Sofi+ds (7' m
Fecal Cloiil6rm (Pomt& mamas)
:s 10 CmOO10imL
Pundg Sias
118 inch di=OW
,/Sd
souDbpmd End Cop
MSA)
0 '
SYS ICK 2CATt[t Nq
O'nedda o[Pnaw- . Dbtdmodan Not• ••R •� try °f UMVJey. vet 30 Wei:
0 " Ia�(ire d SSW Abro eee°n 1 5�017 (APdi 2013-ZQZis �••
75
Pabfi man 9A (98w►w b'mm,.Q
S "bioaed Ca'Poo"* f6od im POM1If►'M Vmum 2.1 (May �-) (bray 2�2-mZ7)
0 Other. Obcd6atoo CaOp°0°°t btaotmnl tw POWM- Vmim 2.1 (Mv 20=-Mn
0 NA
ab►i'tndaiatss�enat l�
P of psfCti�
_ _ PO�i n Cheer tras-m Ja
the oocdmts� Of We WdW nmv" d by a a�� ��� �m� � � � �W odl(s� N� `)c nceodatkow ee deeeaeed bave
at as h om sil a mota e, a!� sl m i dkM mm� *ww w bw sa! cswdtllaas ase fivwm
The FCW=9 owaer is tee0ovalle far t1w apmation and' bommmmo of the POWIS and 0 mbdm of nqd ed mposts. MW gMtky Cad
qOdft5► of to
W%ft W s' I m tM ab& M Pslossaoe and
1038044W Of Your ot(msr �e WNW trnauomat de+irxa and � 60 w�� Aim the � or wmie � �, hm mmovat md
bsefade h �ioa dtafaR shoaid be dsrded b t6* tRs� surf�oe wheaevar posdhte Now: this does not
weft 6eaea► ad *boil solids. aaCltas fFinaaak the dwof find based peas M olk W
be dwbmrpd bfo do syMM O W p W shooid ba misidsed Tor7et tisaw is the oNY PWWst ahonid
dodal Bass. emd ootttan swabs. shn�ld Cot eolsr >he system. C3aotxats. -'PM ftwPons- �Y =Vkhm e+ondoms, aipsege �,.
P'5��
°C°1?��- Canopsattoa afssatistrotwse�s �tsuy case st 10 Some vP-
drinking water supply. Maintain a regular steady%w 9 by spreadin laundry g gh Page $ e t
allsysterttcomponents.Compactionofsnowover the diunit$ �' it to
throu out the week Avoid vehicle traffic over
$parrs] may cause into fit:czc up.
1N5PEG7IONS & h'LAIN�EIYANCIB: Inspection shall be made by an individual carrying one of the follawing licenses or
Maintenance Schedule). rank i Plumber Restricted Sewer, pOWTS Maintainer, or Septage Servicing Operator
identify any cracks or Icales, pections must include a visual ilank (per the attached
measure the volume of combined sludge and scum and check for any to back missing in broken hardto te,
ground surface and test all electrical equipment such as pumps and alarms. Any defects shall be promptly orti�ted E f effluent to the
greater than 8 inches in diameter shall be secured with cffcctive locking devices to prevent accidental or unauthorized en�edta {ks.
try the
When the combination by
of sludge and scum in any tank exceeds one-third (1 /3) or more of the tank volume, the entire contents of the
tank shall bevi tt;g meth ni a SeptMgts Servicing Operator and disposed of in accordance with Ch. NR 113, W iscon3in Admin. Code.
Specific servicing mechanics must be provided if vertical is> 15 feet or if horizontal is >150 feet and instructions to be provided bell
The outlet filter($) shall be inspected and cleaned to
washed from the filter shall be retained in the tank. Filter cleaninove any g accumulated
neces ry at according to meutuf8cturefs
maintenancescheduletok 8 may necesya at more spdcifications.Solids
eepthesystemoperating, D frequent intervals than stated in the
Alarms should be tested on a regular basis by the home awrter. If an alarm sounds, contact an individual licensed to service POWTS,
There is normally a 1 day reserve under regular operating conditions, however water should be construed until an
system are corrected to prevent back-up of sewage into the dwelling or surfacing. Y Problems with the
ABANQONMENT: When the POWTS fails and/or is Permanently taken out of service the following steps shall be taken to ensure that
• s A Piping
to
a and safely abandoned in compliance with Ch. SPS 393.33, Wisconsin Admin. Code.
All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed • After umping, all tanks and its alrsll of by a Septage Servicing Operator.
pumping.
or other inert solid material.a%�� atxS removed or their coven removed and the void space filled with soil,
ON IN N : If the POWTS fails and cannot be repaired the following measures have been, or must 6e taken, to provide a
cods compliant replacement system:
❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorpt ion system. The
replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks
from existing and proposed structutc, lot lines and wells. Failure to pmtect the
systems must comply with the rules in effect at the time of replacement.teplacerrtent area renders it unusable. Replacement
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POW I'S technology a
holding tank may be installed as a last resort to replace the failPO S.
The site has not been evaluated to identify a suitable t ed 11 Wi
be performed to locate a suitable reptacmnent area_ i r no replacement Upon WOf the available a ho
lding POWTS tank MAY ay be installed evaluation a lost
resort to replace the failed POWTS. i
dr Mound and at -grade soil absorption systems may be reconstructed in place fallowing rr-moval of the biomat at the infiltrative
surfttce_ Reconsanuctionsofsuch
systems mustcomply with therules in effectnt that time.
1'AB `INiG!!'.t SEPTIC PUMP, AND OTHER TREATMENT_
OXYGEN. DO NOT ENTER A SEPTIC, PUMP, OR OTHER TREATMENT TANNK UTIAN NDER ��IRCUMSrANCES. DEATH
MAYRESULT. RESCUEOFA PERSON FROM THE INTERIOR OFATANKMAy BEDIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS:
POWTS INSTALLER
Name: ztkyr 11*Adr
POWTS MAINTAINER
Phone: liltr L�]Name: All, W
- rS
Phone:
SEPTAGE SSRViCING OPERATOR Pum r
Name: LOCAL REGULATORYAUTHORI7Y
Phone:
Name: T C,Csit• o d.rr
Phone: 7!j' gL - Lp0
P4. 9 of Q
Maintenance Instmcdons
Biotube Effluent Filter
How to Clean Your Effluent Filter
To ensure your affluent fitter is functioning properly, it should be inspected every year. Under normal conditions, your
effluentfilter will function for several years before cleaning is necessary. The Tihar should be cleaned when it becomes
clogged enough to restrict normal flaws out of the septic tank. At a minimum, the filter should be cleaned whenever the tank
is pumped
Most people prefer to have a septic tank service provider take care of fihar maintenance and cleaning. You can find a
septic tank service provider in the Yellow pages, under'Septic Tanks A Systems.' Or you can contact your county health
d apartment for a list
If you wishto inspect and/or clean your effluent filter yourself, be sure to dress properly. Wear full-langth pants and shirt,
shoes, gloves, and goggles or glasses. Then follow these instructions:
L Remove the access lid to your septic tank by unscrew-
Ing the StaWess steel rid bolls with hex heal tttmaach
provided. If your 5d is above ground, it will be easy to
find. If k is buried below ground, find the =dwrthat
indicates its location.
2 Remove the filter cartridge by Grasping the tee handle
and rlfbng it out of its housing (sfe photo lA
3. Spray the cartridge tubes with a hose to remove any
material sticking to them (sea photo 21 Ensure the area
orifices in the optional flow modulation plate inside the
filter are clear of any debris. Make sure the rinse water
runs back lyda the tank, but do not allow solids material
to fall into the open filter housing.
4. Ftmdy place the cartridge back into the housing.
5. Some effluent filters come with an eiarm that activates
when the frlter needs cleaning. If you have an alarm,
check to make sure it is woddiV by fitting the float
with a stick An audible horn should sound The alarm
panel is normally mounted on the side of the house or
in the garage.
Notes If your effluent filter doesn't have an alarm systarn
and you would Eke one, call your local septic system
installer.
6. Record the date that you inspected and/or cleaned
your fitter on the fa mthtttfoloyas. If you checked the
alarm or made any other obewvv6ms aboutthe tank
or systarn, include that information under -Notes.'
7. Attach access lid by placing it on the riser, rrwmhing
the openings in the Ed with the bolt t:ab:jtm Insert 5d
bolls MW calcites end tighten wkh hex had wrench
provided
ibai I. Plemove tyre Mar cstU fte by MEiap it ow of !Ar
housing.
Phrrm 2 Spray The csrvidge rubes with a hose_
41164Mt
a...rssM
rw3dil
0
����� and P�o�iwidtli �1�1
BUIL EVALUATION REPORT
I Owe l"Ww'd'w+ &WS3lk W AAdaMau*
A���uotlM�a117=1dMriwla�Pl�emtirserJ� �
bo w+d ibr pAwmd by
Fir QMI� . & laedr„hm.
� /'} i '`A' \ ►'g
❑ ttwQen.e,�
AMP" Lomft
art Lot
Lot s gifts
Phom❑ `'�' �Mao.
p�tffmm off` rr�raW—D ft �� �4rtflowr�ipit
C ro
x8 7 . R
subd. �*TP'
asm IQ sm,o*.ft, y() h
caolor
p7E
R�daac
7,ro
�
WWAM I M W,� � 7rW UZI L",..
AM
rd WIN
MA
r
R
o.pe, to apt olor &
do
�C 3
Q
C31 —I
�r
S1 Gp
cb
�(I o�
co
Sr
tN
�c
IM
1
Pt Oroand Suifam atw. .f, Do* to anft bow
}!ate CaaninmtQobt RRdaoc Aatmlpd>Qct gfW
TWttre ; ! t�t>ttor Doundiry Roale
U. AL Cant Ocia Dr. � 81, i
Darktp# (� 8vdnp
❑ Pit Gmund surfs= alev. jL
Hor�cn D!pth Color fion>aMor tfon Taub=
ChL AT.
Maud
COnt C
Do;* lo Onft botor In.
�.
!,_�''
` �Iwnt f S a BOD, > 30 5 M nq& am TSS > 30 S laa myL, ` Effhant $2 = 90R, 3,3() 5 ZW MWL and TSS > 30 9180 rag&
ST CRO NTY SANITARY SYSTEM File #:
Only
OWNERSHIP/ADDRESS FORM � n0 1
Community Development Department will utilize this information to provide the property owner with
information regarding operation and maintenance of your new or replacement sanitary system! This
information will be provided as part of our ongoing efforts to protect public health, your well, groundwater,
surface water, property values, and county resources. Once approved, this completed form and educational
information will be sent to you by email. If you would like to view your issued sanitary permit online, you can
do so by using the PropeM Files Scanned weblink.
Owner/Buyer lI ► I YJ 1-� 4
Mailing Address
City/State/Zip
U
OWNER/BUYER INFORMATION
Phone Number (required)
Email Address (required)
Parcel Identification Number
(found on the property tax bill)
NEW SYSTEM: LEGAL DESCRIPTION
Property Location '/4 , '/, , Sec. . T N R W, Town of
Subdivision Plat: cu-+fe S , Lot #
Certified Survey Map # Volume
Warranty Deed #
_ _ Page #
ZS (before 2006)Volume 1120 page # OgD
Number of bedrooms
New Property Address
(Staff initiate)
(Verification of new
(Date)
Spec house 0 yes 0 no
OFRC'E USE ONLY
Lot lines identifiable 0 yes 0 no
Development Department for new construction.)
This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications.
New System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified
survey map if reference is made in the warranty deed.
Community Development Department — Land Use Division
715-386-4680 St. Croix County Government Center
@sccw�gov 1101 Carmichael Road, Hudson, WI 54016
715-245-4250 Fax
www.sccwi.gQv
DOCUMENT NO WARRAN7V DEED
STATE BAR OF WISCONSIN FORM 2— L.89
Ac.
ST. CROix co
Orville H. L-itt"er and Eleanor M. ReedfotR,�_j
Wj,t."er, husband and wi f e
.. .... MAY 2 1996
-.9:30 A_f,j
caiiveya and warrants to .!. ennls. D. . 1§e-re.ndp and
hx�vbAnd. and wife'"
.. .. ..... .
PXoper.ty
the following described rent estate in . . ...... St. Croix
County.
State of Wisconsin:
Tax Parcel 4o: ....... .. .
The Southeast Quarter (SE 1/4) of Section Ten (10) excepting
thar:2tfrnm the South Forty (40) rods of the East Sixteen (16)
rods of the Southeast Quarter of the Scuthoast Quarter (sE
1/4 of SE 1/4) of Section Ten (10), Townshlp Thirty (30)
North, Range Sixteen West (16 W); and the South One -Half of iI
it
the Southeast Quarter (S 1/2 of SE 1/4) of Section Four (4),
Township Thirty North (30 N), Range Sixteen West (16 W),
Excepting therefrom the East Thirty-four (34) rods and the
West Sixteen I'
(16) rods of the South Twenty (20) rods of the
East Forty -One (41) rods of the Southwest Quarter of the
Southeast Quarter
(SW 1/4 of SE 1/4) of said Section Four II
(4).
This deed is given in full satisfaction of that certain land
contract between the parties hereto dated January 30, 1976 and
recorded in volume 534 at page 60", and 608 as Document No. 331978-
not
hornesLand property.
(is) (is not)
J-,'xC*Pt;oy% tv wnri-at%tic— municipal and
r-Btrictions of record and any
of Grantee.
DuLed thin
(SEAL)
(SEAL)
AUTHENTICATION
Signature(s) ......... ............ ....... ............ .............. .
...... ........... ... I ........ .......................... ......... .....
authenticated this - _ day of_ .......... .. ........... 19
T, I T.- I ... E_: MEMBER STATE BAR OF W_1_SCC)N_Sj_N_1....
(If not,
authorized by g 708.06, wim. St&ta.)
r":S ONSTRUML'"r WAS DRAFTIEin, Uv
...fZP.M.I.N.GT-QN-,-LAW...OFFICES
.. .... OFFICES
...
Juclith A Reminytoll
Niaw.-Riahinond,_W
(3jxnaturr:& may be authcnticateci or 4Lckr,.n%v1td-,vti. ljot)j
arc not necersnry,)
zoning ordinances, easements and
lien created by act or omission
April In 95
{SEAL)
0,RVILLE H. WITTMER)C-1
ELEANOR M. WITTKER
ACKK 3WLRDGP4ENT
STATE OF WISCONSIN
ST. CROIX -s-
.......... ..... ...... County. �
Personally came before nje this
Orviiie .... ii,. w li: tint.
Eleanoj j41-ttmer..; tm
and w. i f.rz:t. J.
to me known to be the Pero"
roreg^ina instrument and nrknov 1d -4
A
I—, r % Pl,hl ic Q I- , Ur 0.1. X Cpu I:%-. Wi,
My Cnrninis�inn i� pernia;tvnt. nf P1 oirnt lnn
do V: : 11) .1
•X af
WARR^14. . DEED ArArp BAK 011 VLIFCON.F.t-4 P..." C.'
DtvWon of iln Induussb�y Seer*u ent co Sal* and Profeaaldnal Services JQ N 2 Pgaa of
SOIL EVALUA-MON REPORT-
-- -�j ttl i,✓ G In accordance with SPS 385, f 0 j
Attach complete sits plan on paper not leas than 8112 x 11 Inches In size. Plan must Include,
but not limited to: vertical, and horizontal reference point (BM), direction and percent slope, Parcel I.D'Olt)
scale or dimensions, north arrow. and location and distance to nearest read
Please print all Information. Rs ad by D to
P nto o ro de ma he used for seoon a u seal P v aw. s—jL3 6?
Property Owner Property Location ❑
13
2 r1 n- 5 rQ ►,Q Govt. Lot vi X Se Y. S 10 T 30 N R I b ZUor W
Property Owners MapnAddress �D Lot # BtoLk # Subd. Name or CS
Yp �t
City State Zip Code , Phone Number ❑ city �Q M11N e TTown Nss"s Road
Oj
= F%o916LU11U=J .Aurti,uvr Ur uavreurrW L uoue cenven cesign now rate L UPD
Replacement [] Publ o or commercial — Describe: {
Parent meterlel .' k: Flood Plan elevation If applicable N ft.
General comma nd recommendationa-
f' Cn►nrrnarv4. Ztto".go1
Q k ze
Barmy # Poring
Pit around surface sbv.�_ -fL Depth to tlmiting factor
1.
®�
mInant ColorIIJJdilri_[il]Jz
••ll
. .r.
awl
Cont Color
;mar
&WA�■■���r��IN
wimp
WIN
Boring #
13011fv
Rpft
c� / U
Ground surface slev./ 75 R Depth to iimfung factor - in.
r
Horizon Depth Dominant Color
In. Munsell
Redox Description ' Texture
Qu.Az. Cant. Color
8011 ARPReadon
Structure Conaletonce Boundary Roots GPDR
car. S• Sh,
g � z'
�
� ►�
'E1
,,� C 5 Z b, b-
3 sire
5' Sd `� H
�t
1
r �!
r
Z a
i - -I— I
rlt r Y �i
C81' name (Please NO
Y
n
C
w=40—ue
'30s 220 rn /Land 30s 1460m
j
CST Number
Address —
Will Heist Soil lS.
•
Date
luatlon nducted
D U
0 L
Telephone Number1�7
W35
Mondovl, W1 541'j�
SBD-8398(RC
(715) 579-,J584
I F 5 Bo" 0
Bodnp R
PR Ground surtaoe elev. l -
Dept to "
MWA
■ter•
..,
�
���
, .
.
-M ME
W, INA
Bonne to I M02 iador
F7Y a PI Ground surface Slay. Depth—�-
Sell A00960 -go
Dolor lialoot Desrrlpticrs Twdum Strachus , ConsWanos Boundary Rasta
Hoamoa l�un�l Cu. Az. Cont. WarGr. SL St.OEM
I
I 1 Bonne o
❑ Bartnp
❑ Pit Ground surface slev. R.
Depth to Itrw" faaw In.
Sag R
JIT
v
• MTli ot a SOD, s 30 5 220 mp/L and TSS > 30 9 150 rnyL . Musnt #2 = SOD. > 30 s 220 mpfL and TSS > 30 s 150 MA&
wmd�
3
\ems_
4� V 7 LO .
cc
0
� � 4
O
00
Nr
kD
z
0
U
mn
4
C
A
p4
A
�,'
lf�
O
w
4
H
O
a
Julie A. Peterson
From: H&H Plumbing, LLC<handhplumbing.colfaxwi@
Sent: Thursday, February 2, 2023 11 :30 AM gmail.com>
To. Julie A. Peterson
Subject: Re: St. Croix County Sanitary Permit Application for Berends-Emerald WI
Thank you Julie,
Kent said the Register of Deeds Office told him there is no CSM for that property.
Thank you for getting back to me!
Haley
H&H Plumbing, LLC
On Thu, Feb 2, 2023 at 11:24 AM Julie A. Peterson <Julie.Peterson sccwi. ova wrote:
Haley
I did find the deed for Behrends in with Newgard- thanks for the heads -up to look there.
I did not find a copy of the lot of plat/CSM for Behrends — was any other paperwork brought in that day I can
look through?
have copied Kevin on this as I am not sure what a contingency plan is- it is on the checklist for us to receive
with a permit es
Hope this helps you,
Julie
Julie Peterson I Community Development - Administrative Services Supervisor
ST. CRO
NTY
,"Wi 11"u
From: H&H Plumbing, LLC <handholumbine.colfaxwi email >
Sent: Thursday, February 2, 2023 10:48 AM
To: Julie A. Peterson <1u1ie.Peterson sccwi. ov>
Subject: Re: St. Croix County Sanitary Permit Application for Berends-Emerald WI