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HomeMy WebLinkAbout002-1029-90-000S't. Croix County Planning and Zoning Thursday, January 31, 2008 at 7:56:13 AM Detail Sanitary Information Page 1 of 1 Computer #: 002-1029-90-000 Sub/Plat: metes & bounds Section: 14 Parcel #: 14.29.16.2126 Lot: TN/RNG: T29N R16W Municipality: Baldwin, Town of CSM: 1/4114: NE 1/4 SE 1/4 Owner: Rein, Edward J. & Joseph E. 934 260th Street Baldwin, W 154002 State Permit: 499162 Issued: 09/08/2006 POWTS Dispersal: Holding Tank Permit: Replacement County Permit: 0 Installed: 09/11/2006 POWTS Detail: NA Bedrooms: 1 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspector As Built Plumber Other Requirements Additional Notes Money Owed Kevin Grabau >4/1/00 -Not Required Bird, Shaun 1998 soil report was in files documenting A+0" $0.00 Ryan Yarrington ~i~~,e~ Citf; Yes conditions and failing system for previous owner - took 8 years to correct problem f~laintenance Scheduled Puma Date Pumped 9/11 /2009 Parcel #: 002-1029-90-000 01/31/2008 07:52 AM PAGE10F1 Alt. Parcel #: 14.29.16.2126 002 -TOWN OF BALDWIN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -REIN, EDWARD J & JOSEPH E EDWARD J & JOSEPH E REIN 441 ROUNDHOUSE ST SHAKOPEE MN 55379 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description ' 934 260TH ST SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 4.850 Plat: N/A-NOT AVAILABLE SEC 14 T29N R16W IN NE SE THE EAST 254 Block/Condo Bldg: FT OF S 857.5 FT OF NE SE TOWN BALDWIN Tract(s): (Sec-Twn-Rng 401/4 1601/4) 14-29N-16W NE SE Notes: Parcel History: Date Doc # Vol/Page Type 11/18/2004 780255 2698/110 WD 11/18/2004 780255 2698/109 WD 10/27/1998 589925 1369/523 LC 06/03/1998 580311 1328/613 SPA more... 2008 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 11/17/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.850 24,700 36,800 61,500 NO Totals for 2008: General Property 4.850 24,700 36,800 61,500 Woodland 0.000 0 0 Totals for 2007: General Property 4.850 24,700 36,800 61,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch #: PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL STATE TOWN OF BALDWIN COMP TER NUMBER 002-1029-90-000 Parcel Number 14.29.16.212B OWNE NAME: First BRUCE E Last HOWELL PROP RTY ADDRESS: Hse # 1/2 PD --Street Name-- Type SD Apartment SECTI~N 14 TOWN 29N RANGE 16W'/<160 '/•40 Line Description Line Description TOT L ACREAGE 4.850 PLAT LOT BLK 01 EC 14 T29N R16W IN NE SE 15 02 HE EAST 254 FT OF S 857.5 16 03 T OF NE SE TOWN BALDWIN 17 04 18 05 19 06 20 07 21 08 22 09 ~, 23 10 24 11 ~ 25 12 ICI 26 13 27 14 28 F1-General, F4-Prev. Parcel, F5-Next Parcel, F7-Valuations, F8-History, F10-Exit Wisconsin Department of Industry, SOIL AND SITE EVALUATION R E P O R T Labv~ and~luman Relations Division of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code Page 1 of 3 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 % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 002-1029-90' l.~'a r ~r~'- APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION VIE ED BY DATE • - 2•Ib• PROPERTY OWNER: ,h,-~ _~,~~ PROPERTY LOCATION Jim Rouleau L-~"~'~ CUy~~ ~~ GOVT. LOT NE 1/4 SE 1/4,S 14 T 29 ,N,R 16 ~ (or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK# SUED. NAME OR CSM ~ 937 Carter Cr. na na na ~Y~~ ~G2G~2~ CITY, STATE ZIP CODE PHONE NUMBER ^CITY ^VILLAGE [MOWN EAREST ROA Hudson, WI. 54016 (71g 386-6858 Baldwin ~~ 260th. st. ~yµ._t^nnctcugtinn i Isa f ~ Residential / Number of bedrooms ,~ 4_ , [ ]Addition to existing buildin jx}c Replay ~ S S~ - Code deri~ ~~~ i, gpd/ft2~_trench, gpolft2 Absorptiol ~j i, gpd/ft2 np trench, gpolft2 Recomme ~ benchma-rk)w -.,~ ~'` Additional.: -~~~/~' `-~~ _> Parent m~ `~C~~~, ~licable ~~~. ft _,i" ~ _ __ S = SUltat SYSTEM IN FILL HOLDING TANK U=Unsu,-_ _ ._, _ ' ^S ®U CAS ^U Boring # 1>'> Ground elev. na ft. Depth to C~~2n~c~jQ~~i~-~/ ~~ l/ -1'/~crr.2e , ,lam-~.~ ~- .~c/ --~ ~~ ~~ Ground elev. __ Wit, . na ft. __ ~_ Depth to ~~ ~ ~ C~_ /l ~/ limiting =c~..e, ~~C.c-l~.~ ~R~61'~ factor ~ ~~ ~ - o~~/- S~o ~! ,~ lr1G~~ ~ _l~~ ~se~ 7!' < sistence Bouxfar Roots G P D/ft y Bed Trerxh Er cs 2f .5 .6 Er gw if .~ .~ Er na na .2 .3 fr gw 2f .5 .b fr gw if .~ •..3 fr na na .2 ~.3 .' ~ ~.,t, ~ ~ ~ ~ w.a ...,.t ~ ~T CROIX ~~~;~ N >,. LON11vG0 i ~„ CST Name:--Please Print Ga L. Steel Phone: 715-246-f address: 1554 200th. v .New Richmo WI 540 7 Signature: Date: 2-7-98 PROPERTY OWNER Jim Rouleau PARCEL I.D. if 002-1029-90 Boring # .............. Ground ~I~v. ft. Depth to limiting factor ~H, Boring # ... 4 .... Ground elev. na ft, Depth to limiting factor ~,!~' Boring # w 5 :~::< ... Ground elev. na ft. Depth to limiting factor ~. Boring # 6 Ground elev. na ft. Depth to limiting factor -65._ SOIL DESCRIPTION REPORT Page ? ~ of 3 .~ i H Depth Dominant Color Mottles Texture Structure Consistence Boundar Roots GPD/ft zon or in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. y Bed Trend 1 0-6 10yr4/2 none sil 2msbk mfr yw 2f .5 .6 2 6-20 10yr4/3 c2d 7.5yr5/8 sil lcsbk mfr na na .2 .3 Remarks: 1 0-7 10yr4/2 none sil 2msbk mfr cs 2f .5 .5 2 7-25 10yr4/4 c2p 7.5yr5/8 sil lcsbk mfr gw if .2 ~.3 3 25-40 7.5yr4/4 c2p 7.5yr5/8 scl lcsbk mfr na na .2 .3 Remarks: 1 0-8 10yr4/2 none sil 2msbk mfr cs 2f .5 ~.6 2 8-20 10yr4/4 c2d 7.5yr5/8 sil lcsbk mfr gw if .2 .3 3 20-48 10yr5/2 c2d 7.5yr5/8 sil lcsbk mfr na na .2 .3 Remarks: 1 -6 10yr4/2 none sil 2msbk mfr cs if .5 .6 2 -25 10yr4/3 2d 7.5yr5/8 sil lcsbk mfr na na .2 ' .3 Remarks: SBD-8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel CSTM2298 MPRSW-3254 N not to scale Jim Rouleau NE4SE4 S14-T29N-R16W town of Baldwin 4.8 acres t /n ~ W ~ / /~~V a Y~~S 1554 200th Ave. New Richmond, WI 54017 (715) 246-6200 t~ ~^~ f~' ~ ld S til a ' \ ~\ ~` ~ ~~, 5 `a V' ~ S~!'-~ ~t ~ r Gary L. Steel 2-7-98 ~~ ~° r~ h ~l `~ n r Z- Wisconsin Depaltment 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 X Township Rein, Ed Baldwin, Town of CST BM Elev: Insp. BM Elev: BM Description: ~aE~ ~ 5 ~ /6 o~. o ;... ~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic r ~+ Z !'~. Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ s ~ BLS' ~ 5 ~ ~J` ~ -- Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model N ber TDH Lift 0.` Friction Loss stem Head TDH Ft Forcemain Length Dia. Dist. to well Still ARSnRPTI()N SYSTEM ELEVATION DIATA County: St. Croix Sanitary Permit No: 499162 0 State Plan ID No: Parcel Tax No: 002-1029-90-000 Section/Town/RangelMap No: 14.29.16.212B STATION BS HI FS ELEV. Benchma k 5;~; 3. I /a3. ~ /csb Alt. BM Bldg. Sewer 5.3 97• ~ SUHt Inlet .~ . Z `1 S. St/Ht Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover 3 • `~T y 9 • Z BED/TRENCH DIMENSIONS Width Length No. Of Trenches _ ~ PIT DIMENSIONS No. Of Pits ~ Inside Dia. -' Liquid Depth ~ SETBACK SYSTEM TO ft"' BLDG WELL LAKE/STREAM LEACHING Manufacturer: ~ INFORMATION CHAMBER OR Type Of System: , I l~ UNIT Model Number: I~ISTRIRUTInN SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length pia Spacing Sell CI~VFR ., o~e~~~~re c.,~•om~ nni.. YY Mnund nr ~t-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ~ Yes l No ~! Yes ' No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / /_ Location: 934 260th Street Baldwin, WI 54002 (NE 1/4 SE 1/4 14 T29N R16W) NA Lot Parc No: 14.29.16.2126 C~J ems. Ol ~. d-~,,,~,~. d-a ~ C ,~,() 1.) Alt BM Description = (J f_ 2.) Bldg sewer length = Z ~ ~ Y -amount of cover= ~ ~~ ~~~~^-~0 Z n I Plan revision Required? ]Yes o ~ ('.t I~ " Of,,,, ~~~j~-µ~ Use other side for additions! information. ~ ____\_. __L Date Insepct s Signat Cert. No. SBD-6710 (R.3/97) ` Safety andgtBuildings Division 201 W. Washin on Ave., P.O. x 7 Coun~ • ~ ~ ~~,~ Madison, WI 537 - 71 Sanitary Pe it u ber (to be filled in by Co.) ~~~~ (608) -31 Department of Commerce Sanitary Permit Applicati State Plan .D. Number ~ 3~ 6 ~ ~ ersonal information y vide Code Adm Wi 83 21 , p . s. . , In accord with Comm may be used for secondary purposes Privacy Law, s15.04(1)(m ~~v~® G Proj ct Address (if different than mailing address) ,~oo I. Application Information -Please Print All Information C~~ ~ b ~ JQ SyZ~ `~ l (J y Property Owner's N r ~~ °~ --- Block # - # L ot ~rcel # \ . ~~ ~X~ _ 0~9 - 9o-OZ7D 2 Property Owner's Mailing Address ~/- S 1 ~ c.J~/ roperty Location ~ y,,,!~%., Section /~ City State ~/ .,~ ) C~--l t- ~ 0 v Z{ip Code J ~ ~ ~ Phone umber T ~N; ~ (ci or e) II. Type of Bu' ding (check all that apply) ~ no~a+er'un~beF 0 2 Family Dwelling - Number of Bedrooms - /~ e ^ Public/Commercial -Describe Use ~ ^ age o ship of City ^ State Owned -Describe Use _ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) '4~ ^ New System B. ^ Permit Renewal Before Expiration eplacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System List Previous Permit Number and Date Issued ^ Permit Revision ^ Change of ^ Permit Transfer to New Plumber Owner IV. T e ofPOWTS S stem: Check all that a l f suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ . o ^ Non -Pressurized In-Ground ^ Mound > 24 in , ., / Constnacted Wetland ^ Pressurized In-Ground '~1-I~icilding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recireulating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching/Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersaVTreatment Area Information: p S stem Elevation Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (s~ Dispersal Area Pro osed (sf) y _ _...-- -Prefab S ite Steel Fiber Plastic VI. Tank Info Capacity in Total Number Manufacturer Concrete Constructed Glass Gallons Gallons of Units New Existing Tanks Tanks Septic or Holding Tank j Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigne a ume responsibility for installation of the POWTS shown on the attached plans. Business Phone Number P m er's Name (Print) Plumber' ature ~~~ MP/MPRS Number Z 7-~ 7/J ~G ~"~~ b Plumber's Address (Street, City, State, Zi ~~ VI . Goun /De artmen Use Onl Sanitary Permit Fee ' cludes Groundwater Date Issued Iss ing nt Signature o Stamps) Approved ^ ppr Surcharge Fee) _ ~ ~ ( ~ ~~ ^ en Reason for enial IX. Conditions Appro ' ~ 1 ~~ S s-~-- ~~'~ SYSTE NER: 1 Septic tank, effluent filter and / -- ~nj ~~ UL~W~. - /~,, 6' S ~^ Ao ~ C 6.0~ ~1~ dispersal cell must all be serviced /maintained as per management plan provided by plumber'. 2. All setback requirements must be maintained as per applicable code/ordinances. Attach complete plans (to the County only) for the system on papcr not less than 8112 x 11 inches in size SBD-6398 (R. 01/03) PLOT PLAN PROJECT Ed Rein ADDRESS 441 Roundhouse St. Shakopee Mn 55379 NE i/4 SE 1/4S 14 /T 29 N/R 16 W TOWN Baldwin COUNTY ST.CROIX SYSTEM ELEVATION TBD BEDROOM 1 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK )OCX MOUND SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 2000 gallon LOAD RATE N/A ABSORPTION AREA none # of chambers none BENCHMARK V.R.P. Top of Well ASSUME ELEVATION 100° Filter Zabel A-100 ^BOREHOLE O WELL *H.R.P. Same as Benchmark Line Scale = 1 /4" = 10' 500' Property Line ~1 ~ Pole Shed with 1 Bedroom Living Quarters Driveway Huffcutt 2000 gallons ~ ce ~oa~a~,~k holding tank Tank is to be properly bedded and provided with lockdown cover and approved warning label Well ~ --_' B.M.* old drainfield ST Tank is to be pumped and buried Property Line Old house has been torn down CpP Soil test on this parcel indicates that the site is not suitable for any other system. Testing does not indicate the need for tank anchoring ~- To be <25' from service road 60th St. ~, commerce.wi.gov isconsin Qepartment of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. com merce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary September 06, 2006 CUST ID No. 226900 SHAUN R BIRD BIRD PLUMBING INC 1008 192 ND AVE NEW RICHMOND WI ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/06/2008 SITE: Ed Rein 934 260th Street Town of Baldwin St Croix Counter _ NE1/4, SE1/4; 514, T29N, R16W Identification Numbers Transaction ID No. 1316624 Site ID No. 717616 Please refer to both identification numbers,.. above, in all corres ondence with the'a enc. . FOR: Description: One Bedroom Replacement Holding Tank Object Type: POWTS Component Manual Regulated Object ID No.: 1094674 Maintenance required; Replacement system; 150 GPD Flow rate; System: Holding Tank Component Manual, SBD- The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. 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: • This holding tank is to be located and installed in accordance with the enclosed approved plans and with the component manual(s) referenced above. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 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. • Comm 83.52(3) The activities relating to evaluation and monitoring POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. • Comm 83.22(71- A copy of the approved plans, specifications and this letter shall be on-site durine 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 including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this appro `~~O.VI,f,T.S. C~ndationally ~~~~~® . ~ , , SHAUN R BIItD Page 2 9/6/2006 • Comm 83.52(1)(a) -The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this holding tank 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 Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. Asper 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 to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon -Fri, 7:15 am - 4:00 pm j erry. swim@wis consin. gov Fee Required $ 60.00 Fee Received $ 60.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 8/23/06 Owner: Ed Rein Location: NE1/4 SE1/4 S14 T29 N,R16W 934 260th St. Baldwin System type: Holding Tank Manuals Used: Holding Tank Component Manual Page# 1. Cover Page 2. Holding Tank Plot Plan 3. Holding Tank Cross Section 4. Maintance and Corttinmencv Plan Signature License number RECEIVED AUG 2 5 2006 SAFETY & BUILDINGS ;:; ;.: u, ,,u„^,h~el~:,t pIVIS~QN n SAFETY AND BUILDt, GS >EE COF<RE5 NDENCE . ~ ~ PLOT PLAN PROJECT Ed Rein ADDRESS 441 Roundhouse St. Shakopee Mn 55379 NE ~i/4 SE 1/4S 14 /T 29 N/R ~6 W TOWN Baldwin COUNTY ST.CROIX SYSTEM ELEVATION TBD 1 BEDROOM CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK XXX MOUND SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 2000 gallon LOAD RATE N/A ABSORPTION AREA none # of chambers none BENCHMARK V.R.P. Top Of Well ASSUME ELEVATION 100° Filter Zabel A-100 ^ BOREHOLE O WELL * H. R. P. Same as Benchmark P Scale = 1 /4" = 10' 5 00' Property Line ~1 ~ Line Pole Shed with 1 Bedroom Living Quarters Driveway Huffcutt 2000 gallons holding tank ~-- ~ ~ a 9, Tank is to be properly bedded and provided with lockdown cover and approved warning label Well ~ ---' B.M.* old drainfield ST Tank is to be pumped and buried Soil test on this parcel indicates that the site is not suitable for any other system. Testing does not indicate the need for tank anchoring To be <25' from service road Old house has been torn down 260th St. Property Line Approved -dent Cap ¢" C.I.- Yent Pipe -Hater Tight--° Seal MOLDING TANK CROSS-SECTION Weather Proof Jurcti on Box' Minimum 72" Final Grade .. - ~ Approved ,Joint ~ ~~ High i+~~4 ' " ~' Ai~r~ S~ri~~r~ ~ SPECIFICATIONS ~ ~ TANK New `~ .Existin . / Manu a~ctu~rer: ~...~,~~j ' Blind C.I. Tank .Size: ~~.~ Gallons Plug ALARM Manufacturer: UDC--~-~,y- ~ j. Model Nt~~r~~~er: c-/ ~wi tch-;Type i r NUMBER OF BEDR003~iS i- GALLONS PER DA`Y: J tSU 3" of Bedding Under Tank 18" Minimum Approved Join w/ C.I. Pipe Extending 3" Onto Solid So Owner's Name : 1~ ~ (~~,,,,~, Address : ~~/ © ~ ~ ~ ~ ~ ~ 7 C Legal Discription:~! ~~ - ~ ~- ~ ~ fLl b~ / Township/Municipality: ~--1~~ _, -~ County :5,~~ ~/~ ~, ~ PLUMBER/DESIGNER Signature: License Number: Date: ved Locking Manhole Cover Warning Label Attached 4" Minimum `` HOLut-~.~-TANK MANAGEMENT P!J\N This Private Onsite Wastewater Treatment System (POWYS) has been designed, and is to be installed and maintained according to Comm ,Wis. AdmiC~ ~ S~itary Ordinance. mponent Manual (SBD-1051-P 6!11/1999}, and the ~'~~ ~L~__.. 1. This POWYS is designed to accommodate an estimated domestic wastewater i4ow of_ gpd. 2. The owner of this POWYS is responsible for system operation and main#enance, including all provisions in the attached Holding Tank Servicing Contract and Maintenance Agreements. 3. Each time the wastewater in the second tank reaches a level of 12° below the inlet invert (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 aad manhole cover(s) and verify tha# the alarm system functions and manhole locking devices are present. Discrepancies are repo ued s~rtary oea! ance and Comm 83 andr84 Wis Adm. Code Restive actions shall comply with the co MY . 5. Ali service events or inspections of this POWYS shall be reported to the county within 10 business days. 6. The owner may not remove any of the wastes from the ho[ding 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 from this holding tank to the ground surface, including intentional~discharges and discharges caused ay neglect, constitutes a failing POWYS and may result in issuance of correction orders or a citation by the county or state. 7. No one should enter a hofdng_tank for anv,reason without being in full compliance with OSHA standards for entering a con#ined space. l`~~"atrnosph~re 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 POWYS faits and cannot be re~~ed, a code ~ spl~ aireplla~er#it) °Connection to be installed fi the same loca#ion (a new sanrtary pe ~I municipal.services would also be considered at this time if they are deemed available to the property. 9. 1# this POWYS is replaced, or its use discon~tf'dneued> components no longer in use it shall be abandoned in accordance with Comm 83.33 Wts. Adm 10. If there is a problem with, or question ab~~ ~1 ~n, the following personsPs oned?~.r-~~~ d y, 1 a. Installer .............. Phone: ?/~ ~S` 7 ~ 1 b. Service Provider ................ ~ ~ ~ ~ t - Phone: ~~ c. County Zoning or Health Dept. •C. i ~ f ~ ~ 11. Project: Transaction: Number. .~ , ELF/~~~ Wisconsin Department of Comme ACT ~ 4 SOIL E ALUATION REPORT Division of Safety and Buildings 2Q04 Page of Jir `'RU~jCnc:e wur~wrnm `'~U C ~, vvis. ram, t.cxie County ~'~ ~ I Attach com lete site lan on a R/1 'NI idtohes a ' size Plan must ~ f~ p p p p . indude, but not limited to: vertical and horizon point ( ), direction and Parcel I.D. 0 ~ p '7 Q ~ 2 / 2 B percent slope, scale or dimensions, north arrow, and loca i istance to nearest road. - QpZ, - P2 -q i b - Please print all information. evie d by Date Personal iMormaGon you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Properly Owner ~ Property Location nn ~ L ,~~ T p Govt. Lot ~% 1 /4 5 1 /4 S N R E ( ) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 3 e ~ -- .- 5 - ,~- City State Zip Code Phone Number ^ C' 44~Vlla a own Nearest Road ^ New Construction U ~ Residential / Number of bedrooms~_ Code derived design flow rate ~y~ GPD Replacement ^ Public r com al -Describe: P rent material Flood Plain General oommeMs and recommendation : / ation if applicable ~ ft. l ( tf ~° 5~~- ~~ # Boring pit Ground surface elev ~ ~ft. Depth to limiting factor ,~ in. Soil lication Rate Horizon Depth Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots GP DffP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 -~ ,a L ------ , ` r, ~,,- Borir>g # ^ Boring Pit Ground surface elev.1~~. Depth to limiting factor in. Soil lication 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 r ~ ~----- L.r , 6" • Effluent #1 = BOD > 30 < ~p mg/L and TS5 >30 < 1 ` Effluent #2 = ttUU < ;su n1g/L ano i ati < 3u mg/L CST Name (Please Print) ignature CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation C nducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 r ~ 715-246-4516 ,~ Property Owner Parcel ID # Page of Boring # Boring '~ it Ground surface elev. v / ft. Depth to IimiGng factor ~_ in. ~I IipGon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP OIff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff# Z ~, ,, b 3 z , -- ~n ~ ~ 6 O Boring # ^ Boring Pit Ground surface elev.%--~ ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DffF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 f / ~'~ .'7' -~' ~ ' O ~ Z r G O. ~ ~-~'L'~ / J~ / ~'~ ~ ~ L7 ~ V a ~~ # ^ Bonng ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil icafion Rate Horizon Depth Dominant Color Redox Description. Texture Stnx~ure Consistence Boundary Roots GP D/fl? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 = BOD; > 30 < 220 mgil- and TSS >30 < 150 mglL 'Effluent #2 =GODS < 30 mg/L and TSS < 30 mglL 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.6N0) Soil Test Plot P Project Name Ed Rein Address 743 Jefferson St. Sh k M 55379 Bird a oppee n (~STM #226900 Lot ------ Subdivision -------- Date 10/1 /04 NE 1/4 SE 1/4S 14 T 29 N/R16 W Township Baldwin Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Well System Elevation none *HRpSameasBenchmark 250' Proaertv Line _ 150' _ ~ 00' B-2 Scale is 1" = 40' unless otherwise noted nn+ B-1 70' 70' 200' 30' B-3 Wel ,~ 50' B.M. 15' Drainfield location unknown (probably next to B-4) Existing 3 30' Bedroom 60th St. 50' 30' House B-4 T 50 HOLDING TANK SERVICING CONTRACT `-~ ,S~- o Holding Tank Ow. 40 2 1~ We acknowledge the of contract is made between the and Pumoer's Name legal on the. following 1. The owner agrees to file a copy of this contract with the local governmental unit that has signed the pumping agreement required in Comm 83.52(1)(c)1. Wis. Adm. Code and the approved Holding Tank Component Manual. This agreement will also be filed with the St. Croix County Zoning Department. 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for a!1rharges *_rsc;YTeu i:. scnii::g the ~~vl;:ng yank(s) as mutually agreed upon by the owner and pumper. The pumper agrees to submit to the local governmental unit that has signed the pumping agreement and to the County, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; f. The volume in gallons of the contents pumped from the holding tank for each servicing; g. The disposal sites to which the contents from the 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 local governmental unit and the County named above within ten (10) business days from the date of change to this service contract. Owjner(s) Name(s) (Print) Owner's Signature(s) Subscribed and sworn to me on this date: C~~+'u.-~J ,~ -off, _ R.e.~ k °$"~P ~` ~ Today`s "^~e _ - - Pumper's Name (Print) umper's Signature ~l`:~x.: Y- public Signatc~e Pumper's Registration Number ~ ---_-Commission.~=xpiratien ~ ~ HANDOLPH J. KUBE$ _:~ . Nofan+ hubli 834Ql3~1 St. Croix County Holding Tank Agreement e late Plan Transaction Number - G~wa t^~ >J ~-e..th Name - (Owner) Typed or printed being duly sworn ,states, under oath, that: 1. He/she is the owner/part owner of the following parcel of )and located in St. Croix Cottnty, Wisconsin, recorded in Vohtmc 2,fdrj$_ Page _[O Document Number ~ St. Croix County Register of Deeds Office: -~80 3.sL 4 parcel of land local din the'/. of the '/s of Section !~__, T_~ N - R ~_ W, Iowa of__~E;~/~i~°+r. CrOI:: Cotmty, Wisconsin, being duly described as follows (include lot no.~and subdivision/CSM or detailed legal description): ~ F~ AJ/' !/Y~ ~'~~+ .IsY.ief- °t;' So~c~_ ~ 5 7•~ ° KATHLEBH H. MALSH RBGISTBR OF DBBDS ST. CROIX CO.. MI RBGBIVBD FOR RBCORD A9/®7/2A0G 64:NPM HOLDEIXHEG~T; HK AGRBBlIHHT REC FEE- 11.0G TRANS FEE: COPY FEE: CC FEE: PAGES: 1 ~~a tit rL~ :1-/0:x:9 -9Q -ood Agrosment Date: ~ ~iJ~ ~' rli` S /y ~`Z, ~ NR, ~~~ Parcel Identiticatlon Number (PIN) t ~KL We acknowledge that application is being made for the installation of (a) hot id ng tank(sf onothe a e described property or that continued use of the exiaUng 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 onaite wastewater treatment system as permitted under Ch. Comm 83, Wis. Adm. Code, or Ch. 145, Wis. Slats. As an Inducement to the county to issue a sanitary permit for the above-described propeRy, we agree to do the following: 1 . 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 oriere Issued by the governmental uNt or the Department of Commerce to prevent or abate a human health hazard as described in s. 254.59, Slats., the governmental unit (Town) may enter upon the property and aeMce the tank or cause to have the tank to be serviced and charge the owner by plating the charges on the tax bill as a spatial assessment for current services rendered. The charges will be assessed es prescribed by s. 68.0703. Stets. 2. 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 speciflcrtions. The owner agrees to be financially responsible for the purchase, installation, maintenance, and repair of the water meter, and agrees to rstlow the govemrnental 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 govemmantal 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 t-e 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 fife 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 govemmentai 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 properly maintained. 6. This agreement will remain in effect only until the county office responsible for the regulation of private onaite wastewater treatment systems certifies that the property is served by either a municipal sewer or a private onaite wastewater treatment system that compllea with Ch. Comm 83, Wfs. Adm. Code. In addition, this agreement may be cancelled by executing and recording said cerUflt:aUon with rofarence to this agreement in such manner which will permit the existence of the certification to be determined by referonce 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 bS the register of deeds in a manner whit-h r•Ail permit the axistenre of the agreement to be determined by reference to the property where the holding tank is installed. Owner(s) Name(s) -Please Print ~ a r R~~ k -.ifo~s< ~ >r ~: Subscribed and sworn to before me on this date: X25-0 Notarized Owners Signature(s) Notary Public t Governmental Unit O I erne. Title -Please Print C sion Expire J, ~((~$E 3/- ~~~ NodirY Pualo-tAilinnccc-- MY t;.SOmrWNen ~Ins..hn 91. Governmental nit Official S azure Drafted by: 10 i=ersdrlai mformauon you prowce may pe useo ror seconcary purpose~nvacy r..aw s. to.uvhitmp "THIS PAGE IS PART OF THIS LEGAL DOCUMENT - NOT REMOVE" This Information must be completed by submltter. document title. pane 8 return address. and ~(LV (!/required). Other Information such es the granting clauses, leagal description, etc. may be placed on this first page of the document or may be placed on addiHona/ pages o/the document. dote: Use of this cover aaae adds one page to your document and 52.00 to the recordina fee. Wisconsin Statutes, 59.517. 1of1 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM ~ ` OwnerBuyer _ ~~. ~ s~~~ Mailing Address y~~ ~• e Property Address ~ °z b ~ (Verification required from Planning & Zoning Department for new construction.) /' Parcel Identification Number d~Z' ~oz~- 9a.- OZ7a l ' ~~~ City/State LEGAL DESCRIPTION ~ ' ert Location r/a ,~~ r/a , Sec.~~ , ~ ~ N ~ W, Town of Prop y _ .----_ (~' ~ (S ~ /~ ~, v ( o ~ t2 C-'C Q21~ ,Lot # Subdivision ~- ,Volume , Page'# Certified Survey Map # Z~j ,Volume _ Z-~° ~~ ,Page `# ~ Warranty Deed # Spec house s no Lot lines identifiable ~ 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 trey P ent stage in the waste disposal sys~m~nOanwnez' maintenance responsibilities are specified in §Comm. 83.52(1) and in Cha ter 1_ - St_ Croix County Sanitary The property owner agrees to submit to St. Croix County Planning & Zoning Department a certidfic~a (1) ~ tm, sit by the owner and by a master plumber, journeyman plumber, restzicted plumber or a licensed pumper ~' f necessary), the septic tank is wastewater disposal system is in proper operating condition and/or (2) after inspection and g p g C less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Deparanent 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 Deparunent within 30 days of the three year expiration date. Uwe certify. that all statements on this form are true to the best of myJour knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. (~ n D ~(.i~J SIGNA OF APPLICANT(S) DATE *** Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Depa~~t*#* Include with this application a recorded warranty decd from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/O5~ ' U 2698P 110 STATE BAR OF WISCONSIN FORM 2 - 1999 Document Number WARRANTY DEED This Deed, made between Bruce Edward Howell Grantor, and Edward J. Rein and Joseph E. Rein Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): The East 254 feet of South 857.5 feet of the NE 1/4 of SE 1/4 of Section 14, Township 29 North, Range 16 West, St. Croix County, Wisconsin. ~~// 5~ Cry 7 80256 KATHLEEN H. iiALSH REGISTER OF DEEDS ST. CROIX CO.. MI RECEIVED FOR RECORD 11/18/2004 09:00A1i MARRANTY DEED EXEINT # REC FEE: 11.00 TRANS FEE: 120.00 COPY FEE: CC FEE: PAGES: 1 Recording Area Name and Return Address Edward J. Rein 743 Jefferson St. Shakopee, MN 55379 uvi-tiny-yw-uu t • F.t ~..u i Parcel Identification Number (PIN) This is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Dated this ~ y ~ ~ day of November , 2004 - -- AUTHENTICATION Signature(s) authenticated this day of * TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stets.) THIS INSTRUMENT WAS DRAI^~~YY P(/~~ Attorney Kristine Oglan_d_ ~_ ~O~'~\ ~n Hudson, WI 54016 ~`~--~ (Signatures may be authenticated or * Names of persons signing in any capacity must be WARRANTY DEED VIRGINIA R~~ ~ ~P.~IOF4N •) -~ ~~, ~~., ~. .. "~. ~~~ ~~~~ * Bruce Edward Howell * ACKNOWLEDGMENT STATE OF Wisconsin ) ss. St. Croix County ) Personally came before me this ,-J t day of November ,2004 _ the above named Bruce Edward Nowell, to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. * V rgini R. Gartman _ ~ Notary Public, State of Wisconsin My Commission is pertnattent. (If not, state expiration date: ~ J January 20, 2008 S Signature. lofortnation Professionals Co., Food du Lac, WI OF WLSCONSIIY 8011.655-2021 No. 2 -1999 ~~ 40' 0' Open storage 0 Pole Shed with 1 bedroom living quarters 10' 12' 18' Bedroom 15' Living room , 7 I J heated shop Bathroom 12' _I 12' Counter top 3' 40 8