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HomeMy WebLinkAbout030-2055-50-000 PRIVATE SEWAGE SYSTEM County: St. Croix Wisconsin Department of Commerce Safety and Building Division Sanitary Permit No: INSPECTION REPORT 538865 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: Bauer, Christopher J. & Holl St. Joseph, Town of 030-2055-50-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: /00--o 00~ 6 k 27.30.20.5456 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. lQG ` Septic n , en, ~O~ D Benchmark 3A 103,0 Dosing ~ v Alt. BM Aeration Q 4 Bldg. Sewer q ` Holding St/Ht Inlet r q2 3 -7 t~ to q3- TANK SETBACK INFO TION >75 /fv /W hdo-lol~url~tYJ St/Ht Outlet TANK TO PP/~r WEL B~ Vent to Air Intake ROAD Dt Inlet ~~ff b Se tic + Dt Bottom d 40 Dosing TF'adlan. 17 ~2 p Aeration Dist. Pir ` ' , _ A .70 - Holding Bot System , L 2- 2~ ! I /J~ 4-v Final Grade / S PUMP/SIPHON INFORMATION - w - Manufacturer Demand St Cover GPM I Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Tren hes PIT DIMEN S No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 4 f VL4(i SETBACK SYSTEM TO P/ BLDG E LAKE/STREAM LEACHING Man ur / INFORMATION z CHA ER OR Typ fSystem: S 'L~z~ UN Model Number: DISTRIBUTION SYSTEM Z 1,t9QfZS CA Ad aaxl Ohs'" n o m0a 4hZe "~;:4 rag/ anif d Distribution x Hoe Size x Hole Spacing Ve t to Air Inta e Hea Pipe(s) p►1G Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil 0 Yes 0 No FRI Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / /7i Inspection #2: Location: 1366 State ~St~~Ho Ito~~~-- (Gov't~,3~'7 TR20W) Village oflHoulton Lot 1 blk5 ~Parcel No: 27.30.20.5->~yB. i 1.) Alt BM Description 1 ~~U' Q US e-j J f"Y~~ US~ r~ f C~ t` 2.) Bldg sewer length = f / 2 y Cti lv ! Iv S ` / 61`-- - amount of cover Lf I'm Plan revision Required? [j Yes No Use other side for additional information. b - Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) PLOT PLAN 1366 State Street Houston, WI 54082 ♦ BM1 Elevation = 100.00' Top of phone ped. A BM2 Elevation= 97.70' ■ Backhoe pits N Slope=2% System Elevation =92.6' 0.43 Acre parcel Legal Description: S27, T30N, R20W Lot 1 Block 5 Village of Houlton Township: St. Joseph County: St. Croix Scale : I"= 30' t co~~►-•C'~ I 0 13 i N / 6 3 10 4 p/L- j 35 J ' ~ r5 ARaPa5~A ~~x s~~i~we~es DR# vE wclc. CAOMI LU S'r 6W N~ add Page 2 of 11 0 Safetyand Buildings Division County 201 W. Washington Ave., P.O. Box 7162 s % , X ► Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) State Transaction Number in Application weed r( In accordance with s. (2), Wis. Adm Code, submission of this form to the appropriate go mental unit is required prior obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Address ( different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary 1366 577,47V 15771 purDoses in accordance with the Privacy Law, s. 15. 1 m , Stats. ©U LTOll1 l 1. Application Information - Please Print All Information Property Owner's Name Parcel # oP qua ~c c ®31 - 2 055- !!Po -000 Property Owner's Mailing Address Property Location 1370 MAN ~ Govt. Lot 3 l 7 f 'i O a Phone Number 'b, Section Z 7 City, State ~ ~(J Zip'Code 144) 0rJ V V ST Z Lot # (c rcleO_ T 0 N; R Z H. Type of Building (check all that apply) { Subdivision Name 5.1 or 2 Family Dwelling - Number of~Bedroo s S/ i e_ Block # ❑ Public/Commercial - Describe Use ❑ City of CSM Number 04 Village of I-IOL4 r0tJ ❑ State Owned -Describe Use ❑ Town of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit N ber and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner ~ f Kk AJd 7 IV. Type of POWTS System/Component/Device: Check all that apply) Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ t-Grade ❑ ound 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) C /y2iY'w Pretreatment Device (explain) In- Dis rsal/Creatmcut Area Information: V. Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Required F0013ispersal Area Proposed System Elevation V1. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units New Tanks s U .40- ~I(i! 3' Yib y Septic or Holding Tank O /OW I t: st CD N Cl~ f TF_ Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' gna re MP/MFRS Number Business Phone Number OOJ 5c4rA(rr ~z ZZ 37~ 0 /S-7C©~© Plumber's Address (Street, City, State, Zip Code) ~~so--H Ave s®~~E~s~: Gr~.r Croz VIII. oun /De artment Use On mre al Permit Fee !Date Issued I m Approved ❑ Disapproved t ~ ❑ Owner Given Reason for Denial IX. Conditions of Approval/Reasons for Disapproval ~ S ~ik^J SYSTEM OWNER: - 1 Septic tank, effluent filter and &0 dispersal cell must all be serviced / maintained ,Q~i~/fi~► ~G ~o-~ ~L' as per management plan prgvided by plumber. MC esta" as per applicable `~'e~o~r i at`n es. 001100-9 and submit to the County on paper of less thaa 8 n i 1 SBD-6398 (R. 10/11) CONVENTIONAL COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: Bauer Conventional In Ground Owners Name: Christopher & Holly Bauer Owner's Address 1370 main St Houlton, WI 54082 Legal Description: S27,T30N, R20W LOT 1 BLK 5 VIL HOULTON Township St. Joseph County: St. Croix Subdivision Name: 0.43 Acre parcel Lot Number: 1 Block Number 5 Parcel I.D. Number 032055-50-000 Plan Transaction No. Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross Section Page 4 Septic Tank Specifications Page 5 Septic Tank Cross Section Page 6 Filter Information Page 7&8 Management and contingency plan Page 9 Septic Tank Maintenance Agreement Page 10 Warranty Deed Page 11 CSM or Plat Attachment Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date: 10/14/2011 Phone Number: 715-760-0486 Signature: In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) Page 1 of 11 PLOT PLAN 1366 State Street Houston, WI 54082 ♦ BM1 Elevation = 100.00' Top of phone ped. 0 BM2 Elevation = 97.70' ■ Backhoe pits N Slope=2% System Elevation =92.6' 0.43 Acre parcel Legal Description: S27, T30N, R20W Lot 1 Block 5 Village of Houlton Township: St. Joseph County: St. Croix Scale : 1"= 30' cot,~a,-A iQ 1 i i 63 B1j ~cce~~~ sa;. 4. PR~po~ty NfloddOes ® ►40Air~e►V~ is vE W c~~ ~ BcDe~'C►~1 ~ O~+rHOUS CA6an! Page 2of11 Soil Absorption System Cross Section 97.00 It Final Grade 4' Sd xWW 40 PVC Vent Pipe 93.60 ft With Vent Cap 4---- Leaching 92.60 ft Chamber System Elevation Soil Absorption System Pian View 44 ft 3 ft Leaching Trench 1 Vent Or Observation Pipe Chambers V Dia. Header Leaching Chamber Specifications Manufactuer And Model INFILTRATOR Quik 4 ESIA Rating 20 sq. ft per chamber ESIA Rating 5.1 sq. ft per 2 endcaps DWF 150 gpd Soil Aplication Rate 0.7 gpd/sq. ft 450 gpd DWF + 0.7 Soil Aplication Rate + 20 ESIA= 11 Chambers 1 row of 11 chambers each. Page 3 of 11 D Z X D m c 61 " 86- > c 42" ~ z r ;u m O N -I ns-. O m + I 41" m _ m [ffu-p- 4" CAS m ( > 1 m 3" 36" 4" I in I ° -n I D D m~ UP 38" m 0 r rm O 4" CAS \m / N 4 1 m C g ;u 'n N0 m 0 0 -o z ° 39" r~ °~Z D m y co D Om D m m 1-10 > ~0;6 0 r mm x nM x D Z G) m -t 0 -40 r = r 2 2 v z D Qm OD D gZ Z DOZ v D 04+D 'mg Fn rny0 ODy Z nm XX v rN v 2r-j-1 > :2 U)° N(~° G) 0 0.... Z (Av mm C7m ~D N rm-IZ o ~ZC - CnF: - rg.. - "r- ~N* N r RZ 0W =C r- t~ Z OX** OZr--3 C.) I id PAmasprmcQl- xx ;K Z v a .0 M o DN Z 6v <Z CO Dm N ilU)m U) Or~~~'''~41 6:1 Q M V Z O ZD r*tm O 0-0 vlmy >1r r~N.p 000- Zn Q 00 C o m o c N ..rte C)- s {C W fnv~ Dr CO a s O Ov G)W c v mm z -1 W n ° -0 ~ q z mi 0 m --I m m m 0 O Z 0m o D p°p° r- OFD >o° ° w°'0 D m o m ~o Z Y m 'O Z C L 0 Z D~ Zv O D "r1 --I Dv O _ D D v 0 00 ~ p Q v O O m N Z C v 0 M OA Ov0 w U) C Z O D ~ o Om o mD ° m ° r W n Z ';0' r JD Z O r v Z m ;u m 1*1 Z In \ cn W1000-MR 2 DRAWN BY. SME SCALE; 1 4"=1'-0" PRE-POUR: ° m SEPTIC MANUAL MIENER COACBETE REV. \ Z W3716 US HWY 10 MAIDEN ROCK, WI 54750 DATE: JANUARY 2010 DATE:. POST-POUR: ° REVISED JAN. 2010 800-325-8456 FlLE: RMWO-W Page 4 of 11 SEPTIC TANK DETAIL / SINGLE COMPARTMENT Project Name: Bauer Conventional In- Ground Tank Manufacturer: Wieser Concrete Tank Model: WLP1000-MR Construction Type: Concrete Steel Fiberglass Polyethylene Tank Volume: 1000 gal Effluent Filter Manufacturer: Bear Onsite Effluent Filter Model: ML3-916 94.25 ft Inlet Elevation Outlet Elevation 94 ft 23" Minimum Manholes w/locking devices ^ < and warning labels - > 'v v .e ■ ■ a ■ st s m & + ■ ■ f ■ a ` s n ■ a. m , . ■ . ■ . a a :a a . s ' ■ ■ ■ ■ ■ ■ ■ ■ ^ C_ V 'IT Baffle Effluent Filter Clear Space / 3" Bedding Under Tank Plumber/Designer Signature: Lic 223760 Date: 10/14/2011 Page 5 FILTER CARTRIDGE INSTRUCTIONS T.20TM Installation STEP 1 Dry fit the filter case onto the end of the outlet pipe to ensure it is centered under the access opening. If not, then either insert more pipe into the tank through the outlet or solvent weld (glue) additional pipe onto the outlet pipe. STEP 2 While the case is still dry fitted on the outlet pipe, measure the length of 3/4-inch pipe needed to brace the filter to the tank end wall if utilizing the optional supplemental side support. If side support method is not utilized, proceed to step four. STEP 3 For installations utilizing the optional supplemental side support: solvent weld the 314-inch pipe onto the filter case. If side support method is not utilized, proceed to step four. STEP 4 Solvent weld the filter case onto the outlet pipe. Insert the filter cartridge into the case, pressing down until the filter locks into the bottom of the case. STEP 5 If a VRS switch is utilized: insert into the filter and lock by turning clockwise 900 Maintenance 1. The effluent filter should be cleaned every time the septic tank is serviced. ~„'W~ • . 2. Open the outlet access opening to inspect the tank and filter. 3. Pump the septic tank completely, making sure to remove the sludge layer on the bottom of the tank and not just the scum and effluent. 4. Once the effluent level has been lowered below the invert of the outlet pipe, firmly pull up on the filter handle to dislodge the cartridge from the case. s 5. Slide the cartridge up and out of the case for cleaning. 6. If a VRS switch connected to an alarm is present, the switch , should be removed by turning counterclockwise 900 and cleaned, with water only. ! 71 While holding the cartridge on its side (large flat surface facing down) over the access opening, rinse off the cartridge with water only, making sure all septage material Is rinsed back into the tank. 8. If VRS switch is utilized, replace by inserting into filter and M' turning clockwise 900. ~A 9. Insert the filter cartridge back into the case, pressing down until 4.j the filter locks into the bottom of the case. 10. Replace and secure the access opening on the tank. BF-AR 6NSf TE" FILTER CARTRIDGE - i-]:VF-YEAk t if - NARRA r1 `r'v •ta f.^4. wi r_ CCd t r -ir r ~ tL'r,G vo. ;~a ~ REAR ONSITE"" Falter Case -Lifetime Limited W 3rr'ar?ty' Ltd ir:+. ,o.YO rj rS °;N 1", POWTS OWNER'S MANUAL & )MANAGEMENT PLAN Page __of FILE INFORMATION SYSTEM SPECIFICATIONS Owner: Chris & Holl auer Tank Manufacturer: Wieser Concrete r NA Permit # Septic - Dose 7 Holding Volume: 1000 gal aim 12 5 DESIGN PARAMETERS Tank Manufacturer: K NA Number of Bedrooms: 1 NA ' Septic - Dose Holding Volume: al Number of Public Facility Units: IS NA Vertical Distance Tank Bottom (s) to Service Pad: ft Estimated averse Flow: 100 gal/day Horizontal Distance Tank(s) to Serivice Pad: ft Desi n peak Flow = estimated x 1.5: 150 gal/day Specific servicing mechanics must be provide if vertical is>15 feet or if In Situ Soil Application Rate: 0.7 al/da /ft2 horizontal is > 150 feet. Specific instructions to be provided on back. Standard Domestic Influent/Effluent Monthly average Effluent Filter Manufacturer: Bear Onsite NA Fats, Oils & Grease (FOG) s30 mg/L Effluent Filter Model: ML3- 916 Biochemical Oxygen Demand (BOD5) 5220mg/L NA Pump Manufacturer: NA Total Suspended Solids (TSS) 5150mg/L Pump Model: High Strength Influent/Effluent Monthly average Petreatment Unit Fats, Oils & Grease (FOG) 530 mg/L Manufacturer: Biochemical Oxygen Demand (BODS) 5220mg/L a NA Mechanical Aeration Peat Filter NA Total Suspended Solids (TSS) 5150mg/L Disinfection Wetland Petreated Effluent Monthly average Sand/Gravel Filter Other: Biochemical Oxygen Demand (BOD5) 530mg/L Soil Absorption System Total Suspended Solids (TSS) s30mg/L . NA X In-Ground (gravity) In-Ground (pressure) NA Fecal Coliform (geometric mean) 5104cfu/100m1 At-Grade Mound Maximum Effluent Particle Size: in dia. N Drip-Line Omer: Other: Other: NA MAINTENANCE SCHEDULE Service Event Service Frequency When combined with sludge and scum equals one-third of tank volume Pump out contents of tanks When the high water alarm is activated 3 ear(s) Maximum 3 ears - NA Inspect condition of tanks At least once every: month(s) Inspect dispersal cell s) At least once eve : 3 year(s) Maximum 3 ears NA MOM(S) Clean effluent fitter At least once eve : 1.5 yea0s) NA month(s) Inspect pump, um controls & alarm At least once eve : year(s) NA Flush laterals and pressure test At least once eve : rear(s) NA month(s) Other: At least once eve : year(s) NA Other: MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Insepector; POWTS Maintainer; Septage Servicing Operator (pumper). Tank inspections must include a visual inspeciton of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicated a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumualtion of sludge and scum in any treatment tank equals one-third ('A) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Admininistrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, petreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. (Rev.2/05) Page 7 of 11 Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During extended power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose and may overload them resulting in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) discharge; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks, pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN permit for If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide the opportunity to obtain a sanitary a code compliant replacement system: ® A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING: TREATMENT TANKS AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES AND LACK SUFFICIENT OXYGEN TO SUPPORT LIFE. NEVER ENTER A TREATMENT TANK OR HOLDING TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK IS VERY DIFFICULT. ADDITIONAL INFORMATION: POWTS MAINTAINER POWTS INSTALLER Name: John Schmitt Name: John Schmitt Phone: 715-760-0486 Phone: 715-760-0486 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name: Apostle Septic Service Name: St Croix County Zoning Phone: 715497-5929 Phone: 715-3864680 This document is intended to meet minimum requirements of Ch. Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. PW 8DQf 11 • Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings ~sl~ in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. _ percent slope, scale or dimensions, north arrow, t road. Q Please prin rmalt eviewed Date 3 Personal information you provide may be u ry purposes (Privacy Law, s. 15.0, 41 (m)). Property Owner ope Location r 9pvG L t 1/4 1/4 S T Q N O E (o W Property Owner's ailing Address ZONINGOFFIC --Lot# Block# Subd•Name orCSM#3~_An 4 3 70 C' Sy't s p Code Phone Number ❑ ity ❑ Village ®,To+yn Nearest d / ❑ New Construction Use:1 Residential / Number of bedrooms Code derived design flow rate GPD [2eplacement ❑ Public or commercial - scribe: Parent material /a~~ Flood Plain elevation if applicable gft General comments and recommendations: Fr-,2 - y3_ z Boring # Boring EZ ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 _ -2 ® Boring # Boring ❑ Pit Ground surface elev. A" ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~ - -z Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 1150 mg/L ' Effluent #2 = BOD 130 mg/L and TSS 130 M91L CST Name ( se Print) Signatu CST Number o~ Address Date Evaluation Conducted Telephone Number 7 Property Owner r L Parcel ID # Page of n Boring # Boring I ~ I ❑ pit Ground surface elev. ~ ft. Depth to limiting factor in. Soil Apprication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD/ffE in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 5; PC_ 95- oeX 2.~ Rio b' - g2.$ F-1 Boring # E] Pit Boring Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *E GPD/fPE in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ❑ Boring # Boring Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil icabon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff 'Eff#1 'Eff#2 in. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. Effluent #1 = BOD5 > 30 5 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOD, 130 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 (R.07/00) Soil Test Plot Plan Project Name Chris Bauer Byron -rd Jr. Address 1370 Hy 35 Houlton Wi. 54082 Zan,= CS #220527 Lot 1 Subdivision BL 5 CSM Date 6/7/2004 CountyST. CROIX 1/4 1/4S27 T 30 N/R20 W TownshipSt. Joseph Boring Q Well PL Property Line# Alt. BM Alt BM 97.7 ,BM or VRP Assume Elevation 100 ft.top of tel Ped System Elv T-1=93.4 T-2=93.2 H.R.P. Same as BM Co Rd. E 10' Bl 13311 B2 96 98' Sta a St. Old sewer Neighb s System t well PL be Rem ved 15' ~30' 28' 33' BM Out House 16, Cabin alt BI 4 PL 5' ~Jf 33-/ 41. t 1Q C > i k 1 p zv„ 00 AD " fix` o =2j BL Ck = a ~ ~ ~ cr o m Nro - r i t a ' - o O O f P c tl~ co O 1 x n /vvala,5,21 ~°/~9~n°' w n : CAI" p lO m (Pi D 520 X71 \ \ W~ I00; ~ tai' y. 1~ w ~ 519 10 IG) W tn~ 00'. 518 a~ 1 r 1. tid 1m ~1 P J -S •A~. _ _--sr.F, \ 517 ro (A OD A 516 B r\) i i h r O ;/7 wv i!®y~v~y _ ~z 1~ y. ~a , se " D 528e en e w 516 A ~y < N ~c,l' • ~ :526. ?'a. .14 3 OD ! STATE HWY. - I CM0 ~ rn cvi D W coo 567 ~p a ,w) v N W W ~I B~K r I 567A - - W ly - - 866 ro s r s 565 - 3 _ (D ax * C11 p ^J o arts.. 564 o W=NE7~' o lk4 563 co J!T 417.50 I , p t0. , ~ a ` n p 13 is,` I N 1 417.50' rt ~k Y z4 I 417.6 1 io M :::may 03/08/2005 Parcel 4130-2055-50-000 12:34 PM PAGE 1 OF 1 Alt. Parcel M 27.30.20.545B 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): Current Owner * BAUER, CHRISTOPHER J & HOLLY J CHRISTOPHER J & HOLLY J BAUER 1370 MAIN ST HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 0.430 Plat: 2111-HOULTON SEC 27 T30N R20W PRT LOT 1 BLK 5 VIL Block/Condo Bldg: 5 LOT 1 HOULTON Tract(s): (Sec-Twn-Rng 401/4 1601/4) 27-30N-20W Notes: Parcel History: Date Doc # Vol/Page Type 11/17/2003 746790 2457/425 WD1 07/23/1997 1144/353 TI 2004 SUMMARY Bill M Fair Market Value: Assessed with: 6178 15,200 Valuations: Last Changed: 06/26/2000 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.430 13,500 1,500 15,000 NO Totals for 2004: General Property 0.430 13,500 1,500 15,000 Woodland 0.000 0 0 Totals for 2003: General Property 0.430 13,500 1,500 15,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer C o7 rt,,t + f cLL r Mailing Address 37 (4/toi Ho 47-aK)4~ Property Address 13&6 S 7-,47-/C .S' i ~?r C T' (Verification required from Planning & Zoning Department for new construction.) City/State It.4ouzi-oty, Parcel Iden tification Number 03 8 - ZOS S~-,~ O LEGAL DESCRIPTION . Property Location STD '/<4, '/4 , Sec. 7 T 3 v N R Z C W, Town of 571 J E>S r Ohl Subdivision Plat: H0" L. -T-E,/0 , Lot # 13- ! l oc v 5- Certified Survey Map # , Volume , Page # V' I ~ay P~ Warranty Deed # 7q6 ZZO (before 2007)Volume 2~ =3Page # Z S Spec house ! yes ?i no Lot lines identifiable ''?dyes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 09/07) l~ U 2 4 5 7 P 4 2 5 7467'3¢) STATE BAR OF WISCONSIN FORM 2 - 1998 KATHLEEN H. WALSH REGISTER DEEDS Document Number WARRANTY DEED ST. CROIXOCO., WI This Deed, made between Eimer K. Nelson and Kathleen Nelson. RECEIVED FOR RECORD husband and wife, Grantor, and Christopher J. Bauer and Holly J. Bauer, 11/1712003 10 : 30AN husband and wife. Grantee. WARRANTY DEED Grantor, for a valuable consideration, conveys and warrants to Grantee EXEMPT # the following described real estate in St. Croix County, State of Wisconsin: REC FEE: 11.00 TRANS FEE: 345.00 COPY FEE: 2.00 CC FEE: PAGES: 1 The North 110 feet of the following described parcel: All that part of Lot Three (3) in Section Twenty Seven (27), Township Thirty (30) North, Range Twenty (20) West, bounded as follows: Commencing at a point 2112 feet south and 390 feet west of quarter post between Section Twenty- Recording Area two and Twenty-seven (27); thence north 248 feet and 3 inches; thence east 100 feet; thence south 84 feet and 3 inches; thence east 71/2 feet; thence south 164 feet; thence westerly to place of beginning. Name and Return Address Ken Nelson 872 174" Ave. All of Lot One (1) in Block Five (5) of the Village of Houlton, excepting New Richmond, WI 54017 therefrom the following: Beginning at the Southeast corner of said Lot One (1), running thence North One Hundred (100) feet; thence West on a line parallel with the south line of said Lot One (1), One Hundred Thirty-three (133) feet; thence South to the Southwest corner of said lot 030-2053-30-000. 030-2055-50-000 One (1), One Hundred (100) feet, thence East to the place of beginning. Parcel Identification Number (PIN) This 5 homestead property. (is) (I~tIICI~ Exceptions to warranties: Easements, restrictions and rights-of-way of record, if any. Dated this day of 4L O e_.-v1 &--1- 2003 Elmer K. Nelson * Kathleen Nelson * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF L0t5r0,,& _ ) - - - ) ss. S authenticated this day of F. ~~/v c, County. ) Personally came before me this day of 20033 the above named Elmer K. Nelson and Kathleen Nelson, husband and wife TITLE: MEMBER STATE BAR OF WISC IIV (If not, to kttown to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats. 0 i ment and acknowledged the same. THIS INSTRUMENT WAS Attorney David J. Estreen * - 304 Locust Street L S -Tv P c of o ;Notary Public, State of L " ('S C W,,f Hudson, WI 54016 Alm , ~My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. ) • Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du Lac, WI STATE BAR OF WISCONSIN 800-635-2021 WARRANTY DEED FORM No. 2 - 1998