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HomeMy WebLinkAbout002-1043-95-000S't. Croix County Planning and Zoning Detail Sanitary Information ;Yfmrday, Jarurary 0'. 2008 at 9:54:13 AM Page 1 of 1 Computer #: 002-1043-95-000 Sub/Plat: NA Section: 19 Parcei #: 19.29.16.2800 Lot: 1 TN/RNG: T29N R16W Municipality: Baldwin, Town of CSM: Vol. 04 Pg. 922 1/4 1/4: NW 1/4 NW 1/4 Owner: Triangle Equipment 879 H wy 63 Baldwin, WI 54002 State Permit: 17552 Issued: 03/31/1980 POWTS Dispersal: Holding Tank Permit: New County Permit: 18 Installed: 06/11/1980 POWTS Detail: NA Bedrooms: 0 WI Fund: POWTS Pretreatment: NA '~ vitas Issuer/Inspector As Buili Plumber Other Reauirernents Harold Barber Yes Powers, Calvin Tom Nelson Yes Owner: Lindus Properties LLC, c/o Kevin & Emily Lindus 879 Hwy 63 Baldwin, WI 54002 State Permit: 463255 Issued: 12/13/2004 POWTS Dispersal: Holding Tank County Permit: 0 Installed: 12/16/2004 POWTS Detail: NA POWTS Pretreatment: NA Additional Notes Manev Owed this 4000 gal. tank was shown on new site plan to $0.00 be abandoned in 2004 and replaced. -file this permit with 2004 Permit: Replacement of Tank Bedrooms: 2 WI Fund: Issuer/Inspector As Built Plumber Other Requirements Kevin Grabau >4/1/00 -Not Required Hudson, Dale Ryan Yarrington Yes ~~, .~~. Scheduled Pump Date Pumped 12/16/2007 Additional Notes Money Owed Commercial system for employees @ 275 gpd - $0.00 installed new 7000 gal. Wieser tank & abandoned old tank. 1980 permit for Triangle Equipment Company filed with this replacement Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT ~~ ..,,.,~~.,~e,.,~+r, rte,.,,,, at ~nn< n~R, rr,r~p 1859 Page _ 1 of - A.C.E. Soil 8 Site Evaluations County Attach complete site plan on paper not less than 8Yz x 11 inches in s¢e. Plan must St. Croix include, but not limited to vertical and horizontal reference point (BM), direction and Parcel I D percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. . . 002-1043-95-000 Please print all information. Reviewed By Date Personal intimation you provide may be used (i secondary purposes (Privacy Law, s 15.04 (1) (m)) I Property Owner Property Location Kevin P. & Emily M. Lindus Govt. Lot NW 114 NW 1/4 S 19 T 29 _-N R 16 W _ Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 2006 South Baker Road 1 CSM Vol. 4, Pg. 922 City State Zip Code Phone Number J City J Village /J Town Nearest Road Balsam Lake I WI 54810 715-684-4647 Baldwin U.S. Hwy. 63 __ New Construction Use: J Residential /Number of bedrooms Code derived design flow rate 27 ~ GPD / Replacement /J Public or commercial -Describe: Office bldg. & warehouse __ __ Parent material Glacial till Flood plain elevation, if applicable na __ General comments and recommendations: No suitable area available for POWTS due to unsuitable soil conditions and limited available area. ^ Boring # ~ Boring Pit Ground Surface elev. n8 ft. Depth to limiting factor ~~~ in. Soil Application Rate Horizon Depth i Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fly _ ____ , in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-3 '~ 10yr3/3 none j sl fill lfsbk ds as 1f 0.0 0.0 -~ ---- __ 2 3-7 10yr4/6 none s fill Osg dl as - I 0.0 ~', 0.0 3 7-23 10yr32 m2p 5yr4/6 I fill Om dvh I cw - 0.0 T 0.0 4 23-36 I 10yr4/4 ---- - - - ' 5 36-51 ~ 10yr4/3 ~ m1 p 7.5yr5/8 ~~ m1 p 7.5yr5/8 siI sl I Om ~ Om dvh deli , cw ~, aw - ~' ~ 0.0 0 2 0.2 T 0.6 6 51-58 !, 5y5/1 m1p7.5yr5/8 ~ c Om mvfi - - ~I 0.0 00 I ~ a Boring # ~ Boring /j Pit Ground Surface elev. na ft. Depth to limiting factor 0 in. Soil Application Raie Horizon Depth I Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO/A' __ in Munsell Qu Sz Cont. Color Gr. Sz Sh `Eff#1 'Eff#2 1 0-2 10yr3/3 ----------- 2 2-5 10yr4/6 none I sl fill none s fill - j lfsbk ,I 9 ' Os ds ! as ---~- dl ! as ~ 1f ~ - 0.0 0 0 ~ 0 0 ' 0 0 3 5-21 10yr32 m2p 5yr4/6 sicl fill 2mpl dh cw ~- 0 0 0 0 4 21-28 ~ 10yr3l3 m 1 p 7.5yr5/8 sicl 2mpl dh cw - 0.0 ', 0.2 T---- --- 5 28-38 10yr4/1 - ,- ---I--- ~ m1 p 7.5yr5/8 ~ -~ sc --- --- Om ~- deli aw j - ~ 0.2 ', 0.6 ~ , 6 38-50 10yr5/1 m /8 cos sc Om mvfi I ai - 0.0 0 0 7 50-56 I 10yr4/6 map 7.5yr5/8 S.Resi Om mfr - - ' Effluent #1 = BOD ~ 30 <_ 220 mg/L a TSS >30 < 150 g/L uent #2 = BOD < 30 mg/L and TSS <_30 mg/L CST Name (Please Print) ignature CST Number ~---- 3602 James K. Thompson _ _ Address A.C.E. Soil 8 Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola 154020 10/212004 715-248-7767 -- ~ ~ onsiri Department of Commerce PRIVATE SEWAGE SYSTEM ty and Building Division INSPECTION REPORT ENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary p:~rpos~ [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Lindus Construction Baldwin Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVAT N DATA TYPE MANUFACTURER CAPACITY Septic ~' C~- Aeration j Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~jcJa' 7 LS' ~ ~ ~ ~ ~ ~ -.- Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss Syst ead TDH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM c°unty: St. Croix Sanitary Permit No: 463255 0 State Plan ID No: Parcel Tax No: 002-1043-95-000 Section/Town/Range/Map No: 19.29.16.2800 STATION BS HI FS ELEV. Benchmark ,/ ~5~6 7 ~~b IG'~ ~~ l~ Alt. BM Bldg. Sewer 1 ~ 4~ ~S . ~~ SUHt Inlet ,~ ~~ ~ ~, yZ St/Ht Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover BED/TRENCH Width Length No. Of Trenches' PIT DIMENSI Of Pits Inside Dia. Liquid Depth DIMENSIONS ! SETBACK SYS TO P/L BLDG ELL LAKE/STREAM CHING Manufac u ON CHAMB INFORMATI Type Of Syste N A' UNIT Model Number: DISTRIBUTION SYSTEM HeaderlManifold (Length Dia (Length Dia Spacing ~ I I I Sn~~ I^Iwi1=Q v Drncc~~rn Qvc4nmc (lnl~i YY Mnunrl (1r Qt.r rarfP Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ~ No 1 Yes ~, No t - ~ - ~ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / /. Location: 879 Hwy 63 Baldwin, WI 54002 (NW 1/4 NW 1/4 19 T29N R16W) NA Lot 1 1.) Alt BM Description = r 2.) Bldg sewer length = f ~ ~' e ^^ ~'~~' ~~ - amount of cover = / 5 ~--~~~ C~~. _ __ Plan revision Re uired? j Yes o i Use other side for additional informs Ion. ~ `~') C SBD-6710 (R.3/97) ~~~~~ ~ ~ C`~' l -I __ II _ - - ---- _. e Insepctq Inspection #2: / /_ Parcel No: 19.29.16.2800 f ,. ~, G ~ '~ ~ ~ ~.. •ti ~~.~ _- - - __ ~ ~~~ ~S Cert. No. Safer and Buildin Divi ~~++~~ ~ ' Y 201 W..~ashin on Av , P.O. F9~ t7 Y , ~ ~ ~aat I 62 Sanitary Pe it Number (to be filled in by CoJ ~seons~n ~ ( I E 32sS ~ De artment of Commerce U . PI .D. Number Sanitary Permit Application sr. cRO,x c . ~ ersonal inform ion y providr Code Wis Adm 21 i h C 83 d ~ g''? 2 g ~J= s ~ ~! - L ONIN , p . . , w t omm . to accor may be used for secondary purposes Privacy Law, s15.(k(1 xm G OFJ=1 ~rojec A dress (if different than mailing address) I. Application Information -Please Print All Information •~K e- Property Owner's Name ~~'r dcd5 Go S r~if ~ Pattx:{ # Lot # Block # 002 foyr3- -pPa (~~ Property Owner's Mailing Address Property Locati/o-n) '/., ~ V" '/., Section City, State/ Zip Code/~ Pyh/once Nu/mb~/er L~/ II. Type of Building (c eck all that apply) C Number ^ 11 r 2 Fatuity Dwelling.- Number of Bedrooms 1 Y G I ~~ ~~ ~ f ~ ~ ~,. 3 6 3 p /C? ,~ , el~ OO ~ 1 1 ~ IF7PublidCommercial-DescribeUse r ^City ^Village ownship of ^ State Owned -Describe Use III. T ype of Permit: (Check only one box on line A. C plete line B if applicable) A' ^ New System Replacement System TreatmendHoldingTenk Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IiV. T e of POWTS S stem: Check all that a l Pass Sand Filter ^ i l ^ ^ ng e S At-C,rade ^ Non -Pressurized In-Ground ^ Mound > 24 in. of~itable soil ^ Mound < 24 in. of suitable soil Constntcted Wetland ^ Pressurized In-Ground IG Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersaVCreatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf j Dispersal Area Proposed s System Elevation ~ r---r ~` ~ ti a rti Z ~~ ~~ //~/ VI. Tank Info Capacity in Gallons Total Gallons Number of Units Manufacturer Prefab Concrete Site Constructed Steel Fiber Glass Plastic New Tanks Existing Tanks ~ Septic or Holding Tank Q ~• 7`/© j Aerobic Treatmem Unit posing Chamber VII. Responsibility Statement- I, the uadersigaed, assume responsibility for installation of the POWTS shown on the attached plans. Plumber' Name (Print) Plu 's Signature MP/MPRS Number Business Phonpt' Nu ~a Plumber's Address (Street, City, State ip Code) ~'a~~~ ~ ? ~ !f l~ ~ Q ~ Gt . Q r,. , r-- ~z® VIII. Coun /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (i ludes Groundwater Date Issued Issuin gent Signatu a (No Stamps) ~ Surcharge Fee) 4~ ~~~~. . l~ "`tttYYY ^ Owner Given Reason for Denial iX. Conditions of ApprovalJReasons for Disapproval 1~~ C1~ ~, S I /S SYSTEM OWNER: 3 i r 1 Septic tank, effluent filter and ~- `' ~~ .~.fl !~ ~~~ S ~ -~ to s d I a i s ne / _ f - n dispersal cell must all be serviced /mainta ement plan provided by plumber. ~A-~j~s ~ ~ t~A,t-te.~. o~y,y.. ~~-- na ~ . g as per ma All setback requirements must be maintained 2 . as per applicable code/ordinances. ~) ~~ , ~ /J_ ~ ~ ~~ At[aen COmpteR pnm tro roe ~.uunry omp n..~.~ •,r^r-• ••-• •--_ _.___ __ __ SBD-6398 (R. 01/03) ~~~~ r ~M Ir p~ ~ Pr'o ~, b, ~~d bar infs. 23~ . .Sc.a~e : / . s~ :. 0 - - - P~f ~`"JQ' ~ bC Sim,%ar .4s p1~ahE ~K:-~~ Prepared 1 /4 dd i ~;?on ~"'~' ~ EX%S'~iilq O~Ce ~~o~ ¢ s~ ~~ ~~/ s,~„~~~ `~`' o -E-- EXiS~in~ st rect GcX(( . ~~~-eea~_ . to 6e insu/a.E{d aslo.~e~eoo%. ~1 ' I~ / O ~ P~oposecJ t.~ccs.c/ ~~ fie, w 700o all. ~ra9e r~lo,fa~;n~y~~n7~. ~hKi&, 6.c,orofc~~ b w ld-.,~ ~ ~ . ' f~-ar» ~f /e~.•c K!a i tra~'¢c. ~ ~~' 8~ - - . --' ~.. ~ravclled Par~in, -- ^ ~ ~ag2 A-~ ea QPP~~x. /oca..fio+~ e~ ~,- ozE.c~,m-~ ust ors I y. ~C~ Sfx~~a~e ~reA ~ ~ 41 41 E33 ~ ~ ~ - ~' commerce.wi.gov i ^ ~scons~n Department 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 Cory L. Nettles, Secretary November 30, 2004 CUST ID No.220853 DALE E HUDSON BOLDT'S PLUMBING & HEATING, INC. 820 MAIN ST PO BOX 78 BALDWIN WI 54002 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 Identification Numbers Transaction ID No. 1087287 Village of Baldwin, St Croix County NW1/4, NW1/4, S19, T29N, R16W FOR: Description: Commercial (Employees) Holding Tank System Object Type: POWTS Component Manual Regulated Object ID No.: 994966 Maintenance required; Replacement system; 280 GPD Flow rate; System: Holding Tank Component Manual, SBD-10571-P (R.6/99); Commercial System SITE• Stte ID No. 629572 Lindus Construction Please refer to both identification numbers, 879 U.S. Hwy 63 above, in all corres ondence with the a enc . CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/30/2006 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, CpndltlOtl stats. ~~~~o The following conditions shall be met during construction or installation and prior to occupancy or use: DEFA 7MEN7 OF C Approval Requirements: OF EYq .~ • This system is to be constructed and located in accordance with the enclosed approved plans and with th $EE CORRESP~ Holding Tank Component Manual for Private Onsite Wastewater Systems" SBD-10571-P (R.6/99). • The plumbing for this project discharges to a private sewage system. The approval covers only domestic/sanitary wastes directed into this system. The Department of Natural Resources must be contacted regarding the treatment and disposal of all industrial wastes. • State and federal regulations prohibit the discharge of hazardous wastes to a private sewage system. Accidental discharge of any hazardous substance to a private sewage system must be reported to the Department of Natural Resources or the Wisconsin Division of Emergency Government. • The existing POWTS must be properly abandoned per Comm 83.33 Wisc.Adm. Code. • 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. DALE E HUDSON Page 2 11/30/2004 • 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. Stat • Comm 83.2217) A copy of the approved~lans specifications and this letter shall be on site during construction and o en to ins ection b authorized re resentatives of the De artment which ma include local ins ectors. • An overpayment of $165.00 was paid. As of today's date, our records indicate that a refund in the amount listed in the FEE portion of this letter is due. The refund will be sent to you under separate cover. Please expect a 6-8 week time for fiscal processing. Refunds will be made to the payer. Owner Responsibilities: • Comm 83.52 Responsibilities. 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. • Comm 83.55 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 All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. 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. 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 to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Charles L Bratz 2~~ POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@ commerce, state. wi. us Fee Required $ 60.00 Fee Received $ 225.00 Refund Amt $ 165.00 WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 CONCRETE HOLDING TANK DESIGN Single Tank Option INDEX AND TITLE SHEET Project Lindus Construction Commercial Holding Tank Owner Kevin Lindus Address 879 Hwy. 63 Baldwin, WI 54002 Legal Description NW1/4 NW1/4, Sec.19, T.29N., R.16W. Township Baldwin County St. Croix Subdivision Name CSM Vol. 4, Pg. 922 Lot No. 1 Parcel ID Number 002-1043-95-000 Plan Transaction ID Number Index and title sheet Page 1 Holding tank specifications Page 2 Site plan Page 3 Maintenance and contingency plan Page 4 Sizing Calculations Page 5 Holding Tank Agreement Page 6 Soil Evaluation Report Page 7 Designer Dale Hudson Signature~~~_ G ~yc~...~'~'~-~ Phone No. 715-684-3378 License Number 220853 Date 11/16/04 Designed pursuant to: Holding Tank Component Manual For POWTS SBD-10571-P (R.6/99) ~~4 ~~ ~~~ F~~ ~~ ~~U~~ `~l0 ~so~ 'n~a~V ,::~. ~~~ -°~1113Et~~~ J ((\\~~L ----~f~l~~ .. JN!)ENCE Version 2.0 (03/01) Page 1 of 7 4 HOLDING TANK SPECIFICATIONS 0 Number of bedrooms 280.0 Non-residential estimated flow (gpd) 2000.0 Minimum holding tank volume required (gal) 7000.0 Proposed holding tank capacity (gal) Wieser Concrete Tank Manufacturer W7000 Tank model number LevelArm Alarm manufacturer DLV Alarm model number Tank Dimensions and Data X for round tank 98.0 Liquid depth below inlet invert (in) 4.0 Maximum depth of soil cover (ft) 112.0 Height (in) Outside 184.0 Length (in) Dimensions 102.0 Width (in) Only junction box - conduit Tank Anchor Calculations Ibs Weight of tank and cover Safety factor Ibs Weight of anchor required in Soil cover req. for anchor or yd' Concrete counter weight HOLDING TANK CROSS SECTION manhole cover with ~- locking device and finished ~ vent cap warning label grade 4" min. ~ 12" min. 24 in. Manhole and vent locations may be reversed. vent pipe 18~~ min. l ~ SeNICR JJJ ~~~ blind plug .... alarm on to seal outlet Electrical as per NEC 300 and Comm 16 12.0 in. 86.0 in - r- building sewer inlet Note: All tank joints, and joints between tank openings and piping are sealed watertight. All pipe and vent materials comply with Comm 84. 3 in. bedding under tank. Tank is anchored as necessary to negate buoyancy. Project: Lindus Construction Commercial Holding Tank Transaction Number: Page 2 of 7 I .. ~ ~• I- .~,np-ercm~ Pr'o {~, b, fcd bar ins. ~3~ Sca /2 r ~ •• = 50• 0 P~.~ - - - - ~ ~ d~cq so:/¢ra~ie~':~, ~'ou.nd t~5 be 5i rr~,%ar ,4s pnl~a~ !~"rK~ n q PfepOSZc1 ~ t ~4dd9~3on--''~' t i t___._ EX%S~ n~ O ~Ce ~ane ed S4~'a~G ~~eel ~vr'et~ G ~,~/S,E: •-,,yy o ,~_ EXi 3-~inq f1 rert . _Te bt~6Rnden Qs p,cr code. ~ "Se~• Sl0 P.r,C, buy"/d;n seiner tv 6~ inSu/a.Etd 4SP~CddQ. 56~~a92 b a: ld;,,~ ~G~ S>`~r'a~Z A~~es~ i /~~ P~opose..c~ lest/ C'ofc.~t fx. cJ 7cov wl1. /lokli~~y~'fRn~. '~nK~Eo 6eArcfec.~~ ,• ~~a~clled PariC;~~ - - - - ~ $' image A-~ era 4PP~ax. /o~~A-, e~ (yccr/; ccr wa~.r 3e~'~i cv ~-' o}Cf tr i or~ tc5l ~ l y, dZ f33 ~ ,.., .,.. 4i B~f ^ ,3of~ HOLDING TANK MANAGEMENT PLAN This Private Onsite Wastewater Treatment System (POWYS) has been designed, and is to be installed and maintained according to Comm 83, Wis. Admin. Code, the Holding Tank Component Manual (SBD-10571-P 6/11/1999), and the St. Croix County Sanitary Ordinance. 1. This POWYS is designed to accommodate an estimated domestic wastewater flow of 1400.0 gpd. 2. The owner of this POWYS is responsible for system operation and maintenance, including all provisions in the attached Holding Tank Servicing Contract and Maintenance Agreements. 3. Each time the wastewater in the tank reaches 90% of the tank(s) capacity or a level of 12" below the inlet (at which time the alarm will activate), the pumper listed in the current Servicing Contract must be called to empty the tank's contents and dispose of them in accordance with NR 113, Wis. Adm. Code. 4. At each service event, the service provider should visually inspect the condition of the tank, risers and manhole cover(s) and verify that the alarm system functions and manhole locking devices are present. Discrepancies are reported to the owner in a timely manner for corrective action. All corrective actions shall comply with the county sanitary ordinance and Comm 83 and 84 Wis. Adm. Code. 5. All service events or inspections of this POWYS shall be reported to the county within 10 business days. 6. The owner may not remove any of the wastes from the holding tank(s), or cause such wastes to be removed by any person not authorized to do so under Ch. 281, Wis. Statutes. The discharge of wastes tank to the ground surtace, including intentional discharges and discharges caused by 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 holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within these tanks may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. 8. In the event that this POWYS fails and cannot be repaired, a code compliant replacement holding tank may be installed in the same location (a new sanitary permit is required for such a replacement). Con- nection to municipal services would also be considered at this time if they are deemed available to the property. 9. If this POWYS is replaced, or its use discontinued, components no longer in use it shall be abandoned in accordance with Comm 83.33 Wis. Adm. Code. 10. If there is a problem with, or question about this installation, the following persons should be contacted: a. Installer ............................ Dale Hudson Phone: 715-684-3378 b. Service Provider ................. Tim Mittlestadt _ _ Phone: 715-665 2112 - -- c. Co. Zoning or Health Dept. St Croix Co. Zoning Phone: 715-386-4680 11 Project: Lindus Construction Commercial Holding Tank Transaction Number: Page 4 of 7 System Design Calculations Lindus Construction Office & warehouse JOB DESCRIPTION: Construction company office & materials storage. System design based on ea+isting facility and proposed addition. Fifteen (15) employees, 2 floor drains, employee kitchen - no food preparation, two compartment sink, no dishwasher, & 5 patrons per day. Design based on Holding Tank Component Manual SBD- 10571-P (8.6/99), 1. Estimated Wastewater Flow: 2R0~ ~ (15 employees all shifts) (13 gal./employee) _ (2 floor drains) (25 gal./drain) _ (Kitchen - 15 meals per day) (2 gal./meal) _ (5 patrons) (1 gal./patron) _ Estimated Daily Wastewater Flow = 195.00 gpd 50.00 gpd 30.00 gpd 5 280.00 gpd 1. Estimated Daily Wastewater Flow = 280.00 gpd 2. Minimum required capacity: t,40o 0o Gattnns 280.00 gpd X 5 day holding capacity = 1,400 gallons 3. Proposed Capacity & Manufacturer: W7000 Wiecer C'nncrere HnldinPTank Pg. 5 of 7 Wisconsin Department ofCommexce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8'/ x 11 inches in siz must include, but not limited to_ vertical and horizontal reference point (B and parcel I.D. percent slope, scale or dimemsions, north arrow, and location and n ~t road. Please print a .~.~ : "~ 0 gy Personal irdormatiar you provide may be u for ~#r7Ptt~1!-~~~, s.1 . Property Owner Pr pe ron 1859 Page 1 of 3 A.C.E. Soil & Site Evaluations St. Croix 002-1043-95-000 Date . ,n~ n.. ~F{. Kevin P. & Emily M. Lindus Go` .Lot NW 1/4 NW 114 S 19 T 29 N R 16 W Property Owner's Mailing Address Lo # Block # Subd. Name or CSIVI# 2006 South Baker Road 5T. CROIX COIJNT'Y 1 CSM Vol. 4, Pg. 922 City State Zi ~i ~ City ~ ~Ilage J Town Nearest Road Balsam Lake ~ WI 54810 715-684-4647 Baldwin U.S. Hwy. 63 j New Construction Use: ~ Residential /Number of bedrooms Code derived design flow rate Z70 j/ Replacement i/ Public or commercial -Describe: Office bldg & warehouse Parent material Glacial till Flood plain elevation, if applicable General comments and recommendations: No suitable area available for POWTS due to unsuitable soil conditions and limited available area. ~ru na Boring # ~ Boring Pit Ground Surface elev. na ft. pepth to limiting factor 0~~ in. Soil Application Rate i ti D R d ture T Structure Consistence Boundary Roots P D/ft~ Horizon Depth in. Dominant Color Munsell escr p on ox e Qu. Sz. Cont. Color ex Gr. Sz. Sh. *Eff#1 Eff#2 1 0-3 10yr3/3 none sl fill 1fsbk ds as 1f 0.0 0.0 2 3-7 10yr4/6 none s fill Osg dl as - 0.0 0.0 3 7-23 10yr3/2 m2p Syr4/6 I fill Om dvh cw - 0.0 0.0 4 23-36 10yr4/4 m1p7.5yr5l8 sil Om dvh cw - 0.0 0.2 5 36-51 10yr4/3 m1p7.5yr5/8 sl Om deh aw - 0.2 0.6 6 51-58 5y5/1 m1p7.5yr5/8 c Om mvfi - - 0.0 0.0 Boring # ~ Boring Pit Ground Surface elev. na ft. Depth to kmiting factor 0~~ in. Soil Application Rate C l D i ti n R d Texture Structure Consistence Boundary Roots GP D/ftZ Horizon Depth in. Dominant o or Munsell escr p o ox e Qu. Sz. Coni. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-2 10yr3/3 none sl fill 1fsbk ds as 1f 0.0 0.0 2 2-5 10yr4/6 none s fill Osg dl as - 0.0 0.0 3 5-21 10yr32 m2p 5yr4/6 sicl fill 2mpi dh cw - 0.0 0.0 4 21-28 10yr3/3 m1p7.5yr5/8 sicl 2mpl dh cw - 0.0 0.2 5 28-38 10yr4/1 m1 p 7.5yr5/8 sc Om deh aw - 0.2 0.6 6 38-50 10yr5/1 m /8 cos sc Om mvfi ai - 0.0 0.0 7 50-56 10yr4/6 map 7.5yr518 .S.Resi Om mfr - - Effluent #1 = BOD ~ 30 < 220 mg/L a TSS >30 < 150 g/L uent #2 = BOD < 30 mglL and TSS < 30 mg/L CST Name (Please Print) ignature~ CST Number James K. Thompson ~'-~ 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola 154020 10212004 715-248-7767 ,~I 2~~88P 5~3.~ Document St. Croix County Holding Tank Agreement tate Plan Transaction Number - ~v' ~dks Name - (Owner) Typed or printed being duly sworn ,states, under oath, that: 1~ 78~~~3 y KATHLEEN H. NALSH REGISTER OF DEEDS ST. CROIK CO. , MI RECEIVED FOR RECORD 12/06/2004 03:45PM HOLDING TANK AGREE![ENT EXERT # REC FEE: 11.00 TRAIiS FEfi: COPY FEfi : 2.00 CC FEE: PAGES : 1 1. He/she is the owner/part owner of the following parcel of land located in St. Croix Coun Wi consin, recorded in Volume /~3~ Page ! 7~ Document Number`'0~'~~St. Croix County Register of Deeds Office: Name and Return Address A parcel of land located in the Rte'/, of the AGE'/, of Section ~_, ~~ din ~;n dus T~Z~ N - R ~(~ W, Town of $a.CdW%n , St. Croix 879 ~lwY (~ County, Wisconsin, being duly described as follows (include lot no. and ~,[dw1~~ ~/ syGa0.z subdivision/CSM or detailed legal description): Agreement Date: ~~~y ~ - /0~3- 9S-axe We acknowledge that application is being made for the installation of (a) holding tank(s) on the above described property or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private onsite wastewater treatment system as permitted under Ch. Comm 83, Wis. Adm. Code, or Ch. 145, Wis. Stets. As an Inducement to the county to issue a sanitary permit for the above-described property, 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 orders issued by the govemmental unit or the Department of Commerce to prevent or abate a human health hazard as described in s. 254.59, Stets., the govemmental untt (Town) may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 88.0703, Stets. 2. The owner agrees, pursuant to s. Comm 83.54 (2), and Comm 82.40(3)(e), Wis. Adrn. Code, to have a water meter installed in the structure. The water meter shall be Installed by a plumber authorized by the Department of Commerce to make such installations, with said installation complying with State .regulations and .manufacturers specifications. - .The owner: agrees-.to be financially restonsible for the purchase. installation, maintenance, and repair of the water meter, and agrees to allow the govemmental 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 govemmental 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 govemmental unit shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notlce. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. 4. The owner, agrees to contract with a person who is licensed under Ch. NR 113, Wis. Adm. Code, to have the holding tank serviced and to file a wpy of the contract with the govemmental unit. The owner further agrees to file a copy of any changes to the service contract, or a copy of a new service contract, with the govemmental 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 govemmental 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 onsite wastewater treatment systems certifies that the property is served by either a municipal sewer or a private onsite wastewater treatment system that complies with Ch. Comm 83, WIs. Adm. Code. In addition, this agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by reference to the property. 7. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit this agreement to the register of deeds, and the agreement shall be recorded by the register of deeds In a manner which will permit the existence of the agreement to be determined by reference to the property where the holding tank is Installed. rs ~ignaturets) ~-~ nit vial Name, Title -Please Print nit Official Signatur >ubscribed and swum to before me on this d. Jotary P Iic .~- ~y Commission Expires )rafted by: on' .~: °. ~,~ .~~.~ ~''r.,.....».. Personal information yt3u provide may be used for secondary purposes [Privacy Laws. 15.04(1)(m)] "THIS PAGE IS PART OF THIS LEGAL DOCUMENT- DO NOT REMOVE" This Information must be completed by submltter. document title. name b return address. and ~l (If required). Otherlnfomtatan such as the granting clauses, leagel descrfpt/on, etc. maybe placed on this fJrst papa of the document or may be placed on additional pages of the document. ,~(gt@; Use of this cover page adds one page to your document and 52.00 to the recorcllna fee. Wisconsin Statutes. 59.517. Oct z9 04 03:10a RHC SEPTIC 7156652112 p.2 HOLDING TANK SERVICING Ct)NTRACT This contract Is made between the ranlcOwrw~{sj Ko) "___- --_-_ ~ ~d ~ r ~~ ----------__ acknowiedge the tnstatlation of ta) hotdirrp tank(s) on the owin ~ ~~ `~ 1!1 ~ rat ,. _ / / , > o ~ .- fl p~~ (p legal descriptions:) _._1. The owner agrees tot~sa d _-.._-_-_--___.-_-__ ---------__--- J -__-----_`-- _ .._..._. ~Pl+ itis contract with tho foce! tlov~srrarrrontat tmlt Eras etgrle~l the p ing 88reernent - tequired In Ch. llNA 83.18(4) (b), Wls, Adrn. Code and with the Carry of ~ 2. The owner agrees to have the hoicGng tanla(s) senAced b!- the pumper and guauanteas to d+~e sar ~~ pu~~ ~~~ ~ of senrickr9 lha holdhQ tanlgs). The awrwrapr~ to m ~ access and Iwmper for ap charges lncumod in serer tarrls(s) with the pumping egWpmern. The owner halher agnies to pay the ht~rtg tanlQs) as tnutu~r eQreed ~ try the owner end pumper. 9. ~ $pumper agn~ to submit to the bcat 9overrNaeratal runt which tray pumps fur~ttr~ er agr~ ~ ~ • a report t~or tho sstvidd ~ i~r k(r~ u~al b~~ The faMowfnp in ttre semianrwat report: a- The name and address d the person t~aponsrble forservlcing the hotdirrgtenl~ b; Tho namo of fhe ownarat tlro troidrrg tatri~ c• Tha kx~tlcn of the property 4n wh~h the h mod: e. T~ho dat~oyrr rr-iPe<mrt thettre ~r Issued torlha trorrg tam t. The volumes In gattorta of t~oonterr ~ . 9- The dEsposaf sites to which the confer ~lnom ~ ~ ~ tens ivr each servicing: rrg torr@ were delhnerad. 4. This agreemarrt v,81 nsmsin M sltect untrl the ~e orvrter agrees to ttie a Dopy d any drarges to thls ~Pm' ~ ills oattract. In the owrrrt of a deartge in this oonbact, 4~emmentat unit and Are County narnod abour3 w~hM far~bi contract a a copy of a new servos coM~ct witfi the focal ( 0) rasinoss days .tr+orrr ttre date of drengs to Iris oervlce contract. a+"~(a) Ufa) (Prt j ~) ~ ,, ~ ~/ ~ Ownera ,~ V~"V l J /" /~ , 1~` ( \ 8114 i1Ni0RI ~D ~fi8 OR ~IiO Yalu. r r T $ tats r , I 1(V//(~,v// r C~ ~~'l~ , G~ ~ ~l ~ r ~ ~~ ~~ ~M'ihJfA ~~ pie ~, ~01~~~0~, ~ lb"~~~~ g ors ~~125 ~~ ~Yn 5~ ,~1 ~T99P 5~3 St. Croix County Ho/ding Tank Agreement State Plan Transaction Number - 1{-CVi/~ L.~dks Name - (Owner) Typed or printed being duty sworn ,states, under oath, that: 1. He/she is the owner/part owner of the following parcel of land located in St. Croix Corm Wi cousin, recorded in Volume /Y3(o Page / 7F Document Nttmber~ ~'~~St. Croix County Register of Deeds Office: A pazcel of land located in the /J6J'/. of the ~'/. of Section /4 T~_ N - R ~_ W, Town of ~etLalW//l , St. Croix Cottnty, Wisconsin, being duly described as follows (include lot no. and subdivision/CSM or detailed legal description): Agreement Date: t ( ~5f o 7 8 1 8 3 3 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIK CD. , XI RECEIVED FOR RECORD 12/06!2004 03:45Pit HOLDING 'TANK AGREElfENT EXE?fPT f« RSC FEE: 11.00 TRAtIS FEfi: COPY FEfi : 2.00 CG FEfi t PAGES: 1 Na'^~o and Rotum Address (' p B79 may. ~3 ,6rr,lm/u~li, cJ/. 6f~~ c~.t- /os/.3- 9S-cam Parcel Identiftcatton Number tPINI We acknowledge that application is being made for the installation of (a) holding tank(s) on the above described property or that continued use of the e~dsting 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 mun{cipat sewer, or any other typo of private onsite wastewater treatment system as permitted under Ch. Comm 83, Wis. Adm. Code, or Ch. 145, Wis. Stets. As an Inducement to the county to Issue a sanitary permit for the above-described property, we agree to do the following: 1 . Owner agrees to conform to aU applicable requirements of Ch. Comm 83, Wis. Adm. Code relating to holding tanks. If the owner fails to have the holding tank property serviced in response to orefere issued by the governmental unit or the Department of Commerce W prevent or abate a human health hazard as described in s. 254.59, Stets., the governmental unit (Town) may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing the charges on the tax bill as a speGal assessment for currant services rendered. The charges wiU be assessed as prescribed by s. 88.0703, States. 2. The owner agrees, pursuant to s. Comm 83.54 (2), and Comm 82.40(3)(e), Wls. Adm. Code, to have a waist mater 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 compivinp with States renutatlon8 and manufacturers specifications. The owner s~grees to be financially resnonslble tar the ourchase Installation, maintenance, and repair of the water muter, and agrees to allow the governmental unit or the Department of Commerce to enter the above-described property on a regular basis to read and/or inspect the water meter. 3. Owner agrees to pay ail charges and costs incurred by the governmental unit or county for inspection, pumping, hauling, or othervvise servicing and maintaining the holding tank in such a manner as to prevent or abate any human health hazard caused by the holding tank. The governmental unit shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the dais of notice. In the avant the owner does not pay the costs within thirty (30j days, the owner spedftcalty agrees that all the costs and charges may t>e placed on the tax roll as a specie{ assessment for the abatement of a human health hazard, and the tax shalt be collected as provided by law. 4. The owner, agrees to conVact with a person who is licensed under Ch. NR '1'13, Wis. Adm. Code, to have the holding tank serviced and to file a copy of the contract with the governmental unit. The owner further agrees to file a copy of any changes to the service contract, or a copy of a new service contract, with the governmental unit witttin ten (10) business days from the date of change to the service wntrect. 5. The owner agrees to contract with a person licensed under Ch. NR '1'13, Wis. Adm. Coda, who shall submit to the county on a semiannual basis a report detatHng the serviGng of the holding tank. The governmental unit or county may enter upon the property to Investigate the condition of the holding tank when pumping reports and meter readings may Indicate that the holding tank is not being property maintained. B. This agreement will remain In effect only until the county office responsible for the regulation of private onsite wastewater treatment systems certifies that the property is served by either a muntcipai sewer or a private onsite wastewater Vestment system that complies with Ch. Comm 83, Wis. Adm. Gods. In addition, this agreement may be cancelled by executing and recording said certJflcatlon with reference to this agreement in such manner which will permit the existence of the certlflcatlon to be determined by reference to the property. 7. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit this agreement to the register of deeds, and the agreement shall be recorded by the register of deeds In a manner which will permit rho existence of the agreemen! to qe determined by reference to the property where the hoidtng tank Is InstaOed. Owner(s) Name(s) - Pl e a se Print Subscribed and sworn to before me on this date: / /1 / ~ otarized whets Signature(s) ~-' Notary P is . y-. O - fi .: t 3f f.~ --_ ve me tai Un t al Name. Titte -Please Print y Commisslon Exp[res Go ante! Unit Official Signatur Drafted by: ~UC.IyL ~ Om~ ..w..-, . 1~ Personst rntormauon you provide may be used for secondary purposes trnvacy uaw s. -io.ual-r 1tm11 "THIS PAGE IS PART Oh THl3 LEGAL DOCUMENT - DO NOT REMOVE" E~ r This information must be completed by subrrNUer. document title. name 6 return address. and ~ (N required). Other Jnfomtatior such as rho grenting clauses, !saga/ description, etc. may be placed on th/s f/rst page of the document or may be placed cvt addlllavra! payee of the document. tloto: Use of this cover oeoe adds one nape to your document and 52~00~ the recordirw fee. Wisoonsinn Statutes, 59. b17. v 1436p~~~176 This Deed, made between Hehli-Vold Corporation, a Wisconsin corporation, Grantor, and Kevin P. Lindus and Emily M. Lindus, husband and wife as survivorship martial property, Grantee. Wltnesseth, That the said Grantor, for a valuable consideration of one dollar and other valuable consideration conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin: ~~~~~~ KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 46-22-1999 9:30 AM YAItRANTY iDEEiD EXElIPT t CERT COPY FEE: COPY FEE: TRANSFEit FEE• 675.00 RECORDING FEE: 10.00 PAGES: I Recording Area Name and Retu z/ Thomas A. McCormack P.O. Box 157 Baldwin, WI 54002 002-1043-95 (Parcel Identification Number) Part of NW '/. of NW '/. of Section 19-29-16 described as follows: Certified Survey Map filed February 29, 1980 in Volume 4, page 922. This is not homestead property. Together with all and singular hereditaments and appurtenances thereunto belonging; And Grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, highways, utility rights and reservations of record, and will warrant and defend the same. Dated this r }~+~ day of June, 1999. AUTHENTICATION Signature(s) David Hehli authenticated this '>~-~-. 'David Hehli, President fj u-FLa ~ ~ day of June, 1999 signature Thomas R. Schumacher type or print name TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by§70t3.o6, Wis. Stets.} THIS INSTRUMENT WAS DRAFTED BY Thomas R. Schumacher Baldwin, Wisconsin (Signatures may be authenticated or acknowbdged. Both are not ACKNOWLEDGMENT STATE OF WISCONSIN 5~-~i~SR6flE COUNTY ..•••••••••,,. Personally came before me this ~VdfiyKof Jun~•'1.~99 the above named David Hehli to me k wn„~o tie'the~,p~Fson(s) who exec ted the foregoing instrt+Jment Apd acd~litvledgo the same. C ~ F t ~ : ..1 .. signature j°' "' ~`'~• type or print name '"7-.., ,4 I-r+Li:t?.f~. B~ if !o Notary Public-Stt County, Wisconsin. My commission is permanent. (If not, state expiration date: "Names of persons signing in any capacity should be typed or printed below their signatures. /D Informelion Prorecsionalc Company Ftxlo du Lac, VNCCOruln BOOE55.2021 ~~~~~8 ~ _, ~~ i;i: v~ ~t`~~ F EB 29190 `` ~• Q- t~ °' c°KKau ~~ ct D~od~ ,`jV i4 Gtolx ~~~ ~ WIC Cv S ~ NW. CORNER `e~~~`~~sC~NSi,`'y~.,, S RICHARD D. BOOTH ~ e S-1413 j T= I e ~ CLEAR LAKE. WIS. t s ~~ ~ ~~ ~ g,,I ~ a~1 O ~® ,,~ LIC ~ ~ 50~ 4 ~jo ~~ 0 ~`'~ 0 o,''b O o .9 2, cn q O 5.0 ACRE S ~ ~ ~ al~soaoo sq• Ft - o _ 0 =o ~' o ~.5~ AGR~S t ~ ~ 19 7, 800• oo sq• F~• ~ o O ~ o ~ XGLUDING R~ W ~ ,~ ~ ~~ ~~ ~ ~, ,. ~~ o .~~ ~~~ ~ ~~~ Op EXISTING ~`~' s ~~~a3-o E X- P.K. ~F9'~ So' '~~~ ~ PRINT OF ~~G-NN l N G CERT IF~ED SUR~~y PART o~ T~~ NoR7NW~ST HAGF OF THE NORTN~WFESE~T pN %9 Ta9/~- ONE-FOUR\TN OF WISCONSIN R.I6W TO CROIX COUNTY, p~pN~ ~qSS .._:,.c •PERCOLATI6N -Tr-aENK WILL. ~~ P~.(~ e w ~ o~Z uV~ 2 ~~ °~o~ °E ~.s~~ ? F..~ ~ cn¢~ ~~~~ • SO ~ NO~~ I l~G yp u s t+ m~°"~ R~S1p~NT aUl ~ ~ -rp 6~ P~IDo :SHou~-D W FED W11.1~ ?N~ ~SCRO APPROVED ~=1'/~+~IRON PIPS ~1N FT w7. 1. !3 I.n./ T6 8 f ~~ FEB 2 01980 Si. C~01X COUNTY Q ~ ~ GOMPREHEN5IVE PARKS PIANNINd i~i~ _- ~ - ,. o, roc' SCR LE I=/0~ ~N F~ i ' AS-BUILT SANITARY SYSTEM REPORT QWNER u TOWNSHIP SEC.~~N, R~W ADDRES'S ~ ST. CROI TY WISCON IN . SUBDIVISI N LOT LOT SIZE PLAN VIEW Distances & dimensions to meet requirements of H62.20 -- SNOW EVERYTHING WITHIN 100 FEET OF SYSTEM i ~ i i_ .~ , ~' ;; . I t I I I I I I I ~I .~.._~ ~ ,~ ~ ~ ~ ~ I It~di~atte ~Tv~A"row i ~ ~ ! ~ JGALL' : - i r t TANK(S) MFGR. J",~? ~~~„~ ~~ CONCRETE T1~EL~_ e ,J 0. o rings on cover 1 Depth ~- '' ~~ PUMP~NG CHAMBER SIZE PUMP MFGR. M DEL N~.~ GALLONS Per Cycle ~~ TRENCHES. N0. of wi tc~i - i length ar. ~ "~ t`' BED N0. of lines width length are;~,•, dep~~to top o~ pipe NUMBER OF SEEPAGE PITS Outsi a iameter total pity:=,area AGGREGATE PERK RATE AREA QUIRED AREA AS BUTL Disclaimer: The inspection of this system by St: ~roix~:Ccbt~nty' doe.` not imply complete compliance with State Administrative Codes. There-are other areas that it is not possible to inspect at this point of .construction. St.-Croix County assumes no liability. for system operation. However, if failure is noted the County will make every effort to determine cause of failur GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH THI ,~ ~- DATED lp ~~- 8p PLUMBER ON JOB .~.Q,~,i„~ oG,~,~~ LICENSE NUMBER ~ S"/~~ ~~ Z _-- ,• 'REPORT 0~' INSPECT~JrJ_INDIVIDUAL SEGlAGE SYSTEM ~ -~ San.~Zany Penm~.Z ~~ . S.ta~e SQp-t~.c /~~-~~~ NAME ,~~--z~--~ ~,~.~- , iz_~_ ~,~.~rowna h.~p .~ .~-~~~~~~~`~ ~ v' S~. Cno.ix County ~ ~j • ~. laca~.~ore ~%.- - ~f,CliSec~~.on ~ _ SEPTIC TANK -- S.~ze ~~~ ga~.~ond. Numbers o~ Compars.tmen~.d D.cd~ance Frsom: Gle.~.Z ~m~ ~#. 17$ on gnea~en a.2ope ~ ~# • Bu~~d~,ng ~O ~#. we.t~anda - ~~. DISPOSAL SYSTEM D~.a~ance Pnom: FIELD DIMENSIONS: H,i-ghwazen a ~z. Bu,i..~d~.ng S~. H.~ghwazen ~~. 12$ on gnea~en a.~ope ~~. G! ez~and.a P~. W.idzh a ~ ~rsench fix. D ep~h o ~ no ch b e~.ow ~~..~e ~.n . Length a~ each .2~.ne SZ. Dep.th o~ nocfz oven .t.i,~e .in. Numbers. o~ .~~.ne~ Depth o~ .t-%.2e be,2ow grsade tin. To#a.C .Zeng~h a~ Q~.ned ~Z. S.2ope o5 ~nench .gin pen 100 ~~. D.ca~ance bexcveen .2.Lneal~z. Depth ~a 6ednock ~~. Toxa.C aba anb~.~on anew ~~2 Depth ~o gnoundwa~en ~~. •• Requ~.rsed anea ~~2 Type o~ Cavers: PappJi an S~r.aw PIT DIMENSIONS: Numb en a ~ p.L~.a Ou~~.de d.~ame.ten ~.t. Toxa•2 abbanbx~.on anea Arsea nequ~.ned Gnave~ around p.i~ yed na Depth 6 e.~aw .bn.~e~ S~t. 2 ~~ ~~2 INSPECTED By TITLE APPROVED .,DATE ~ 197_. REJECTED ,DATE ~ 197_. 4~~/~~-~~~~' z A rn r :. .. .:y,~s•~...: .. ~T ~~~ r~ a~i ~ - { e +~~ -t `~~ '~` t r 'tom r a ~ N ~ ~ ~,. 3 ~~,~ ~...' ~ ,Ls ~,~~~r.,r {k $.'IR tSl .. "".~ .Tf~ M L~+' ..~f ~~~. ,.,~~~1 s• ~~`,~$. _ F 7M' F f '' t C~i~, ~~ f ~lj, ~ ~ ,~¢Z ~i ~ ?.' ~ g"' tt~i ~'.~ ,y~ s 7 y 14 a x~i,h ~ 4 ~ ~ k v(. ~~" ~N~ ~:~ ~f y ,~Zi y r~ ~, y.~ r( S~° {Py' ~ ! ~ ~ ~y~ ,. ~"'s y;^ f ~ , iw ~ A8+'~~~~ c ~t, ~ , y s o .. 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J .F jr t ). .: '4 r '.. i .:. 8 Y •y F "' rd V.i11~~fik~)~~ ~ ~~r wit FY ~~a, F .v 4 ,y• Ryl t r3.i ~~yc a. ~~,~17~~r~ y ~ ~,~Sj. 1~3,y~~ M+,Y `' >~ { ~,4 ~r f ~` Y t ~ `. ;~{~ ~ ; '~~ ~-}- v r~`~ s k t~~ \ ~ } ii?~ 4 t~9R~ .r°,' ~ vfi_~A l y -~. :' f t ' t#~~ ~ t 4`~ '~'*`~d~-'~~ _;t~ ~' ~ ~~P ~ k~ 4,~4`~rrT ,thxj~~y'- > +~ ,~f * s~'H ~-F ~ ,},~I ~ ',~Y $~ .:°i r, 4 '`~ n ~y~ 7 "`. f~ ,r -` ~y ' " ~~ at-t, ~~, ~n~ r i ~. 1m ~ ~ `. r ~ ~ .,4 s "'~ ~, S* ~a X.i ,s' _ f,;'!+5 ~- ~~,_ y, ;;'.~ '~k' » t .'Jo-.. '~ ~.. ~=s ~'. y.','t %'~i ~ ... .w~ > 't'. M. ,:~...,.. .. ....r.'t:.ia.'~m" 'Na iat''r.. a z _..~' . a~~ 4 E ~ ~ ~ ~ Rev. 9/78 REPORT ON SOIL BORINGS AND PERCOLATION TESTS ~, WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION:wc '/<, ww'/., Section~,T~N,R~1~(or) W, Township or Municipality ~u JG~ WI'^ Lot No. ,Block No. <-~ r County ~ u iwsi ~e Owner's/Buyers Name: Mailing Address: TYPE OF OCCUPANCY:. Residence No. of Bedrooms b COMMERCIAL ,~_ EFFLUENT DISPOSAL SYSTEM: NEW,~_REPLACEMENT ALTERNATE SYSTEM OTHER_wT DATES OBSERVATIONS MADE: SOIL BORINGS -~"i fr ' ~ D. PERCOLATION T^ES^T•S ' SOIL MAP SHEET CO ~ NAME OF SOIL MAP UNIT ~/`a-~~Y Si ~~" ~I"7 ~v y"- PERCOLATION TESTS TEST NUM DEPTH CHARACTER OF SOIL HOURS S -H WATER IN H T TEST TIME NTERVAL DROP IN WATER LEVEL, INCHE RATE - BER INCHES THICKNESS IN INCHES INCE OLE 1ST WETTED OLE AF E SWELLING I iN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN P- P- C P- P- P- P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, MOTTLING AND DEPTH TO BEDROCK TEXTURE NUMBER INCHES OBSERVED ESTIMATED HIGHEST , IF OBSERVED IN INCHES B- ~ 7z ~ 0 1+ t. o-z -~~G~ j B- B- B- !r, r-` PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the ioc n an are feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy " ~ dicate scale or distances. Give horizontal and vertical reference points. Indicate slope. / S -f~d ~ ~ ..~ ... w ~ - ~~ ~j~y.~;nc~ ~ ~ ~ J _ ~. ~ . _ _ ~ _ ~ _ __ _ m .~ P ~ ~ ~_~. ~ _ ~ ~- ~ ~ _e. _ ~ _~~._ . .r E _ _ e _ _ ~ ~ . , _ e `~ _ ~ \ i f i ~v ~~ i s _~ P~ ~. _ _s __ . . _~. ~... ~, ~~® ... _ ~.~., ~._.. ~ _ _ ~ ~N E ~~ .~_ ~~ ~ 1 s ~ s 11 ~ ~ } ~ ? 1 ~ ~ ~ fJ ~ y.......,~_ ` : ' __ ,~_._~~_ . ... _ ~_. _ .~.e. . _ ti ~ ~ ~ ~. ~ ` _ ~ .._m ~~__ ~~~ ~W_; ~, __ __. _ ;.~ ;~ ~ -~ P ~ ~~ ~ ~ ~ ~ ~~ ~ ~ / ~ E ~ .._ ~ a~ ~~ ~ _ . : e_ A~ . _ ~ __ ~_. ~ ~ . _ . a M q ~~ _ ~ _ ;~ E ~ ~_ ~. ~__-~- ~~ ~_... ~ ~ . e_ __~_ ~_ I, the undersige ,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisoor~in Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. ~ Name (print)._.(.,.c$ Address ..Name of installer if Copy A -Local _ ---, Certification No. S s ~ '~ ''T ~ ' 7 State and County State Permit # /( ~`~ P~L ~ ~ ~ P r it li tion County Per 't ~ ~0 ~ e m ANr ca ~ ~ for Private Domestic Sewage Systems County ti *DENOTES STATE APPROVAL REQUIRED Q ~© ~. ~~~ Date Approval Received from State if Required ~ ~°zO ~ U U State Plan I.D. # ~ Q A. OWNER OF PROPERTY Mailing Address: , B. LOCATION: 4 Ya, Section T~ N, R E (or) Lot# _~City Subdivision Name, nearest road, lake or landmark Blk# Village ~ ,5 ~ Township ~ ' (.~' C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) Variance Single family Duplex No. of Bedrooms No. of Persons D• SEPTIC TANK CAPACITY Total gallons No. of tanks HOLDING TANK CAPACITY ~ ~ Total gallons No. of tanks_~ Prefab. concrete Poured-in-Place Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefa b concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Perc ation Rate Total Absorb Area sq. ft. New Replacement Alternate (Specify) Seepage Trench: No. of Lin t. Width Depth Tile depth (top~_ No. of Trenches Seepage Bed: Length Width De pth Tile depth (top- No. of Lines-- Seepage Pit: Inside diame r Liquid Depth No. of Seepage Pits Percent slope of {and Distance from critical slope WATER SUPPLY: Private Joint ^ Community ^ Municipal ^ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I Have sized the e ffluent disposal system from the EH-115 prepared by the Certified oil Tester, NAME C .S.T. # J~J -~,31 and other information (~~~ obtained from ~ ~w (owner/builder). I Plumber's Signature P/MPRSW# ~,.5~ 3 Phone #~~-.S/.j.~ __ Plumber's F.ddress ~ .5 PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. Do Not Write in Space Below - FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Applicatior~~ ;3~-8 ~ _Fees Paid: State ~©D County ~ d Date -- Permit Issued/ (date) 3 `-3~ - g~ Issuing Agent Name Inspection Yes No State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 ~ _ _ .~cr! ~~q U1~7~ne~fi ,~ J J ~.,~~~ ~ ~ ran ~I S ~te~1~~~n ;~~~~ ~ ~ s c '~ /3` Q ~ r^~""` ,~ +3 ~~ s i Q .~ ~~ 3 ~~ pp4 ___ ___ _ Scg1 e ~ ~_-- y ~ .d Qprth YrQV~k, ~ l.' c,o Pa~~~~ ~~~ ~~ 3 ~ ~ ~~ ~ ~~V is~~, ~ ~91.~!'~~'~/ ~~ ° nd Face ~Y' ~ °' ~,~,~,.. Sys'' i S~Lt °~ta o{~~'~~~~ ,. .~ ~~° '''`~ ~ ~ J Qar~~~~ ~ ~ 'p r ~ v ~e ~Z I 0 ~ P~k. ,~y ~, RECEIVED MAR 1 91980 P1-~1M811V® $EDTIAIY 1~~ ~L Plb. #' 60 1 X78 ' NAME OF BUSINESS ,5c~ PROJECT DETAIL DATA SHEET ~ ~ ~ O 6 P _ .. ~ . LEGAL DESCRIPTION /J}'~ J1~ ~ Sze, ( ~ T~ ~' N - ~ ~ ~ ~ OWNER S~r- ~~~ , Pm~,~..~' ~nC, - MAILING ADDRESS C I..~a ~ ~~~.~ _ (,J~ s ~ ZIP ARCHITECT, ENGINEER, ~~, ~ a ~ e rs ADDRESS /~~c~7Ql ~ ~,,,~a,.,, ~ ~ S c PLUMBER OR DESIGNER ZIP.~'ya 1 7 TELEPHONE NUMBER 1. Check appropriate building usages) and fill in the information requested opposite each usage listed. Please consult Section H 62.20. Existing building New building ~_ Addition ( ) Apartments and condominiums Number of bedrooms ( ) Assembly hall Seating capacity ( ) Bar Seating capacity # of meals served ( ) Bowling alley Number of lanes ( ) With bar ( ) Campground and camping resorts Number of sewered sites Number of unsewered sites Total number of sites ( ) Camps ( ) Day use only Number of persons ( ) Day and night Number of persons (l~ Catchbasin Number ~ ( ) Church ( ) No kitchen Number of persons ( ) With kitchen Number of persons ( ) Dance hall Number of persons ( ) Dining hall Number of meals served daily ( ) Dog kennels Number of enclosures ( ) Drive-in restaurant Inside seating capacity Car-service -- Number of car spaces (~) Dump station Number of dump stations ( ~ Employees ( total of all shifts) Number of employees ~ ( Hotel ( ) Motel ( ) Cottages Number of units with 2 persons per unit Number of units with 4 persons per unit ( ) Medical and dental office bldgs. Number of doctors, nurses, medical staff Number of office personnel Number of patients ( } Mobile home parks Number of sites ( ) Nursing homes Number of beds ( ) Parks Number of persons ( ) Toilets ( ) Showers ( ) Restaurant Seating capacity ( ) Dishwasher and/or disposal? ( ) 24-Hour service QC) Retail store Total number of customers /1~ ( ) Schools _ Number of classrooms ~ Meals ( ~ Showers ( ) Self service laundry ~ Total number of machines ~ O IvE0 ( ) Service station Number of cars served daily r~1NR 1 ( ) Swimming pool bathhouse Number of persons 9 ~98(+~ ( ) OTHER (Specify) TIOM COMPLETE OTHER SIDE 2. Indicate whether the following facilities are present. Floor drain yes ~ no Number of ,drains Food waste grinder yes no ~_ Dishwasher yes no Automatic clothes washer yes no Number of clothes washers .+ 3. Septic tank capacity Holding tank capacity ~ Q Septi c or holding tank manufacturer " Th ~ C~ ~ n`r~ (`n ~ ~~ mn~s ~0 5 k i i1s~ G11 s c 4. SEEPAGE TRENCHES: total square feet ~} C:~y~ 2 width of trenches length of trenches SEEPAGE BEDS: SEEPAGE PITS: number of trenches depth total square feet IU o v~ e width length of bed depth total square feet ~; U Yl ~°_ outside diameter depth below inlet total depth from top to bottom of pit Signature of person completing form: Address _~ ~ ~,.~ ~,,~ It i c. ~ rn n ri ~i W~s~ ~,-~ zip 5y~~~ Telephone Number ~ / ~' -- a ~/ ~ - -~j .3S Date ~ ' /~ ~-- ~U FOR DEPARTMENTAL USE ONLY Approved - y the 1?~parfirrent of Health and Sacicsi Sereices division ~~f-iealf~h Chief ~~ ~-->/ ct~on a;: Pi~n-~'sng~d Fire lfrctecfion Syst S .. ~xan~iner J ~ ~e w ST.CROIX COUNTY WISCONSI N ZONING OFFICE 796-2239 __ P. 0. BOX 227 Hammond, WI 54015 O W N E R P U M P E R A G R E E M E N T PLEASE $E ADVISED, That until you are again notified, I will contract f with ~`-~~~-`~ --~ '~ c.,' o f ~-~ ,~.~L~ ~ ~ _ ;~~~ , Wisconsin, (Pumper), for the purpose of removing all waste from the sanitary system to be located on the property and future building site n d located in St. Croix County, Wisconsin, Township of -~~~ ~~~c-~`~ being in the d~-~-~4 of the ~,/ ~ ~~ 4 of Sec. ~, T.~~ N-R ~~ W. or more fully described as follows: Dated this .~~ day of -~ ~~~' , (OWNER) State of Wisconsin ss County of St. Croix Personnally appeared before me this ~ day of ____11~ ~ 19~~, the above named to me ownwn to ~e the person who execute the oregoing instrument an acknowledg `the _same Notary P lic, St. CroiX ,County; WI _ My Co ( permanent) (Expires_ /'''~ ~ c - State of Wtsconsfa ` ` a , 1 ~ - 3 7 f a43G Commission ~xp~rea Jcw,,1;z j8Q4' I, ~~.,,-....~ hereinbefore referred to as jumper, join in t e a ove greement o the extent th I have contract with Owner as above stated. c~ ~ (PUMPER) ST. CR01 X COUNTY WI SCO NSI N Z O N I N G O F F I C E 795-2239 HAYJIl~IOiJll , WI 54015 Elmer N. Lecy Safety & Building 201 .E. Washington P.O..Box 7969 Madison, WI 53707 Dear Mr. Lecy: We recived a call from Triangel Equipment, R.R. 1, Baldwin, WI, indicating that they did not yet have State Approval. I am enclosing a copy of the stamp that shows he has approval. The date of "the appro~Ta'_ is 3-20-80 with number 80-'00712. If you have any further questions, please feel free to contact this office. You truly, ~. / ~~ ;: Harold C. Barber HCB:sl Enclosure April 2, 1981. ' a 4 ~ t N ~ Nf~-~i~(~ b-NIbuYN~p- J 08616 T ~dW ~ 4 r1 03A13~~' ~ ~' © S J S ;`t ~ ~ ~ ~ ~ w ~ ; ~ ~~ l~ ~, ~ ~ ~ ~ ~ ~ / _ Q n O t~ ~ C ~ ~ ~ ~ ~ T , Q ~ ~ ~ ~~ w ~ ~ a ~~ a .r ~ ~ ~ q ~ U U ~ ~ ~ ,~ ~~' ~ ~-# vJ -- Q-- .~ ~ t ~ ~~~~ _ `' N _N v N ~~ Q ~ ~ ~~ J R ~ /) O ~ ~'n ~~ o ~ ~ o ~ ~i << ,~ ~ ~ ~ ~~ r ~ ~ v ~ `~ ~ ~ ~ Q y ~? 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