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HomeMy WebLinkAbout004-1003-90-100 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 488226 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Market, Michael Cady, Town of 004 - 1003 -90 -100 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: / < T 02.28.15.25A10 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. R, �- 5 7. g /0 7- •oa Septic ;:,,., y .1 Benchmark Dosing 6 Alt. BM r gs N Ovw ASR Bldg. Sewer U).." f e�.� Z '� • 02.9 Holding St/Ht Inlet 1D,5 97.35 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet 0j� i � Dt Bottom Septic �3g �3 Z ' 75 75 I+ 93 d5 Dosing 1 / 3 Z " 7 5 / –16 — Header /Man. 4 Aeration Dist. Pipe 4,9 /02 . Holding Bot. System S - 5.5 i oZ , 35 - Final Grade If PUMP /SIPHON INFORMATION 3�C1 /°3 fJ5 Manufacturer Demand St Cover 3 •��j 1D1 4� � o 3 , 615 4 G` e.L. GPM � I �. T Model Number /V 1 C) sZ $ C 4 ��� /0/ e,n a u� TDH Lift Friction Loss System Head TDH Ft /o 2 .7 5 3•� �le�l Forcemain Length. 0 I Dia. I II Dist. to Well l3Zr SOIL ABSORPT SYSTEM BED /TRENCH Width Length No. Of Trees PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS \ \ SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION 44 1 CHAMBER OR Type Of ystem: A' / UNIT Model Number: •1 139 7$ DISTRIBUTION SYSTEM Header /Manifold / / Distribution I x Hole Size / I x Hole Spacing Ven Air I Length 3 Dia L Length 3 Dia r!! Spacing f 6 'J-�" j SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center / . /_ Bed/Trench Edges � Topsoil I Ik ' es No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /b / /d / Inspection #2: Location: 546 315th Street Kn p WI 54749 (NW 1/4 SW 1/4 2 T28N R15W) N Lot 1 p Parcel No: 02.28.15.25A10 1.) Alt BM Description = W 5. a '� GIB q � - - s 2J Bldg sewer length = r 1 _ � • b �� sa! d, - amount of cover = / � ` rG4. �-o c�t5 Q �• ' art• r Plan revision Required? F : ] Yes KNo Use other side for additional information. _ _ Date Insepetor's ignature Cart. No. SBD -6710 (R.3/97) Safety and Buildings Division County 201 W. Washington ve., P.O. Box 7162 Cro, IV " Isconsln Madison, Wl 07 - 162 Sanitary Permit N (to be filled in by Co.) Department of Commerce (6os) is SBZZ Sanitary Permit Applica State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal inkrinatim you provi / Z- �6 9 S' $ S may be used for secondary purposes Privacy law, sl ject Address (if different than mailing address) 1. Application Information - Please Print AA Information �t - 51� 315 9 547• Property 's Name 1 # Block # Property Owner's Mailing Address Location 546 31 5 �`-ST" w City, State Zip Code Phone Number '/ti MW '/4, Section /L 6 Par 5 - 4 7 1 f' 7 ~ Q »3 a T� N; R le W (i 25/ r 6 d H. Type o wilding (check all that apply) 2 Ole 4� ir 1 or 2 Family Dwelling - Number of Bedrooms 3 S�,yk� Subdivision Name CSM Number ❑ Public/Commercial - Describe Use �i`� h4h Q 1 r [3 State Owned - Describe Use �' oU o y �PJL►C� ❑City_ ❑Village ownship of Ill. Type of Permit: (Check only one box on line A. Complete line B if applicable) DO 4 - 1603 _ — I &n A. New S tem ❑ Replacement ys Rep System ❑ Tteatmmt/Holding Tank 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 1V. Type of POWTS System: Check all that appl ❑ Non - Pressurized hr -Grand A!r" >- 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized ht-0roumd ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter . RecirculatinSyntbaticMediaFilter CILawbinSChamber ❑ Dri line ❑ Gravel -less Pipe ❑ Other (explain) (L- V. Dispersal/Treatment Area Information: Design Flow (gpd) I Design Soil Application Dispersal Area Req ' sf) Dispersal Area Propce sfl System Elevation VI. Tank Info Capacity in Total Number Manufacturer Ardab Site Steel Fiber Plastic Gallons Wow of Units r[ Concrete Cmstructed Glass Now Existin Scptic oF44eWin&44ek �+o Sao ff � Acrobic Tmatment Unit Dosing Clamber n� �/i VII. Respo nsibility Statement- 1, the rn (/�/ sur nsibitl for installatlon of the POWTS shown on the attached Plumber' (Print) Pl S' MP/MPR3 Number Business Phone Number 40 rlr' 7tlr 235= Z4V Plumber's Address (Street, City, State, Zip A r loo ? ?OF /h/£. e%— d j W A*re C aZ J V ?t! Vu1. Coon /De partment use ❑ : App roved Sanitary Permit Fee (includes Groundwater Date suroharge Fee) S5 O f iz n ❑ rm ^^ nn 1X. Conditions of ApprovaMeawns for Disapproval 3 J Lo..d� �-e cry 5 d e. r Jea1(� r! .2 c ` SYSTEM OWNER: 1. Septic tank, eftluent filtttr sod dispersal cell must all / as per managemwt plan Mvkled by per• 2. AN setback requiWnertts mud be Makttairted as per applcable code / ordWww. s. Attack eomplate plans (to the County only) for the system on papa net loss dmn 81l2 x 11 Inches V size SBD -6398 (R. 01/03) N MARKET SITE 02.28 -15W 546 315TH STREET CADY TOWNSHIP ST.CROIX COUNTY, WI W rBUILDING SEWER MUST COMPLY E I WITH COMM 82.30 WAC (11)(C) I O � PARCEL DESCRIBED AS 14+ AC. LWTHIWDNRCHSL R8t1C 8j2 J Q r //�► � �`Cr/ 0 4 1 � SCALE (� BENCHMARK ELEVATION = 100.0' -nail in tree o LOCATION OF SOIL BORING(S) I / / p NA E 0 LOCATION OF SOIL PIT(S) ( / / / / / , / // 0 15 30 (* NO APPARENT COMM 83.43 SETBACKS ® DESCRIBED LOCATION OF LOT LINE (UNLESS SHOWN OTHERWISE) I I ® LOCATION OF RIGHT -OF -WAY ® CENTERLINE OF DESCRIBED ROAD WILLIAM J.BERGH I--- ------ ------J WISCONSIN CERTIFIED SOIL TESTER / / / / 80.0' X 6.0' DISTRIBUTION CELL DESIGNER OF ENGINEERING SYSTEMS / / j / WITHIN A MOUND COMPONENT CUSTOMER ID 227819 VEHICULAR T 10"07'COMPA�FI C PROHIBITEp / ` . , (103) __ - -- -- ---- - - - -�� (— L _ L _ L _ L _ L _ L — L _ L _ L — L _ L _ L _ L 0 80'- 2" SCH 40 PVC FORCEMAIN PLACE UPSLOPE EDGE OF CELL (must drain back to pump tank) ALONG FLAGGED 101.00' CONTOUR PROPOSED L _ L _ L _ L _ SYSTEM ELEVATION = 102.35' BUILDING SITE I I I I r _ L L _ L _ L _ L _ _ _ _ _ L _ L _ L _ L _ 4 1 I I i I I I L L- ( I 1 L I L ! i __L_L___L I I I I ! ! I I I I I I I 1 L_ L _ L _ L _ L _ L _ L _ L _ L _ L _ L L _ L _ L _ HUFFCUTT MODEL 10001600 { SEPTIC/PUMP TANK -35'- 4" ASTM PVC (w/approved outlet filter) BUILDING SEWER LINE 0 M w O n J N MARKET SITE 02- 28 -15W 546 315TH STREET CADY TOWNSHIP ST.CROIX COUNTY, WI ( BUIL9ING SEWER MUST COMPLY W E I WITH COMM 82.30 WAC (11)(C) I PARCEL DESCRIBED AS 14+ AC. W TH R CH W NS. N 811 & 81 2 L C' NNFF S r ---------- - - - --� & BENCHMARK ELEVATION = 100.0' SCALE I - nail in I t o LOCATION OF SOIL BORING(S) ( / / /� /// y• / / / / / / / / / / / / / / / /, /'//////� I * LOCATION OF SOIL PIT(S) I / / / / j // ;DR,��w %/ 0 15 30 1 * NO APPARENT COMM 83.43 SETBACKS (UNLESS SHOWN OTHERWISE) I ® DESCRIBED LOCATION OF LOT LINE ® LOCATION OF RIGHT -OF -WAY ® CENTERLINE OF DESCRIBED ROAD WILLIAM J.BERGH I---- ---- - -- --J WISCONSIN CERTIFIED SOIL TESTER / / / / 80.0'X 6.0' DISTRIBUTION CELL DESIGNER OF ENGINEERING SYSTEMS / / /// / WITHIN A MOUND COMPONENT CUSTOMER ID 227819 / 14 6 _ �O NO nu- P ROH %B/TfD //DISTURB SD/C #4 (103) _ - - -- -- ---- - - -��, # SW.2 "SCH40 PVC FORCEMAIN \ must drain back to um tank PLACE UPSLOPE EDGE OF CELL L _ L _ L _ L _ L PROPOSED ®L _ L _ L _ L _ j ( p ump ) ALONG FLAGGED ELEVA TION 'CONTOUR SYSTEM ELEVATION = 102.35' f I I I I I BUILDING SITE f I I I I I_L_L_L_L_LL- L -L_ I I f I I f I I I i I I I I L_L_L_L_I I I I I i I I I I I I I I I HUFFCUTT MODEL 10001600 I_ L_ L- L- L_ L- L_ L_ L_ L_ L_ L_ L_ L_I SEPTIC /PUMP TANK -35'- 4" ASTM PVC (w /approved outlet filter) BUILDING SEWER LINE D O M C4 O n 0 Y Safety and Buildings PO BOX 7162 commerce.Wl.gov MADISON WI 53707 -7162 TDD #: (608) 264 -8777 isconsin www.commer isco gov/sb/ www.wisconsin.gov Department of Commerce Jim Doyle, Governor Mary P. Burke, Secretary May 19, 2006 CUST ID No. 227819 ATTN: POWTS Inspector WILLIAM J BERGH ZONING OFFICE GEO TECH ST CROIX COUNTY SPIA 2667 113TH ST 1101 CARMICHAEL RD CHIPPEWA FALLS WI 54729 -6575 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/19/2008 Identification Numbers Transaction ID No. 1269885 SITE• Site ID No. 712963 Michael Market - Dwelling Please refer to both identification numbers, 546 315TH St above, in all correspondence with the agency. Town of Cady, 54749 St Croix County S2, T28N, R15W FOR: Description: New Mound System / 450 gpd Object Type: POWTS Component Manual Regulated Object ID No.: 1076087 Maintenance required; 450 GPD Flow rate; 20 in Soil minimum depth to limiting factor from original grade; System(s): Ezflow Mound Component Manual, (N.6/03), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 /01); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. P.O The following conditions shall be met during construction or installation and prior to occupancy or use: COn a 1. On page 3, the system plot plan does not show adequate parcel location information as specified in the approved mound system component manual. AP OE K 2. On page 3, as specified in the approved mound system component manual, the system plot plan must show the direction and percent of the slope in the system area. 3. On page 4, an observation pipe detail was not provided. Observation pipes shall have a minimum diameter of 4 inches, provided with a watertight cap, have the bottom six inches vertically slotted, and provided with a suitable means of anchoring. Refer to Figures 11 and 12 of the approved mound system component manual for complete details. 4. On page 4, the mound observation pipes shall be located at a junction point between two units so as not to create separation of the bundles within a product. 5. On page 4, the dispersal cell shall be covered with approved geotextile fabric that conforms to s. Comm 84.30(6)(g)., Wis. Adm. Code. The fabric shall be laid over the EZFlow product and extend WILLIAM J BERGH Page 2 5/19/2006 down along the sides to a point at least 6 inches from the system elevation. This is approval stipulation #1331 as found in the Wisconsin Plumbing Products Register. 6. On page 5, a center feed force main to the distribution network shall have the following characteristics as specified in the approved EZFIow component manual: a. Due to the size of the EZFIow product, a center feed mound will have a small separation in the center of the mound that is equal to the diameter of the force main. b. Insert the shoulders of the tee into the EZFIow 4 pipe as far as possible to minimize the size of the gap. This can be achieved by inserting the 4" plug into a corrugation that is far enough into the EZFIow pipe so as not to impede the shoulders of the force main tee from being fully inserted into the EZFIow 4 11 pipe. When finished, the gap will be only as wide as the diameter of the force main because the EZFIow bundles on each side will be butted against the force main. c. Backfill the center gap with mound sand. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. 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. i 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 j/ Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 c� P ter E agel Private Sewage Plan Re�ie er , Integrated Services WiSMART code: 7633 (608)266-2889, M - F, 0630 - 1500 Hrs pete.pagel@wisconsin.gov cc: Glen N Pelke , Glen Pelke Plumbing (Plans Mailed To) Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 I , per Table 3 - EZitow � 14 .0' Mound Manual H o. 8'- 80.0' L 10.8' 101.6' Distribution laterals terminate at the end of the distribution cell O Access box covering threaded plug at the end of each distirbution lateral / EFFECTIVE BASAL AREA I ELI II DISTRIBUTION CELL i7 F, EZflow COMPONENTS DISTRIBUTION LATERAL (typical) * All discharge orifices are located per the EZflow Mound Component Manual ` final grade final g rade rad <6" threaded cap threaded cap access box 1 112 DISTRIBUTION LATERAL access box 2" FORCEMAI N/MAN I FOLD —39.0' 24" 2 —X 78.0' last orifice(s) are located 12" from end of cell Discharge orifice diameter 3/16" = 0.1875 X/2 spacing 12" Number of orifices per lateral 20 X spacing 24" Total number of orifices (all laterals) 80 ORIFICES MUST BE LOCATED IN A (4 UP -1 DOWN) SEQUENCE (DRAWING IS NOT TO SCALE) PAGE 5 OF 10 Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks of leaks, measure the volume of combined sludge and scum and to check for any backup or surface discharge of effluent. Access openings used for service of assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental of unauthorized entry into the tank. The outlet(effluent) filters) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank during cleaning. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating properly. ✓ Pump Chamber/Treatment Tank(s) Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must me made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of the filter. Any service needs or repairs shall be promptly taken care of. ✓ Mound, At- Grade, In- Ground Pressure i The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground must be promptly reported to the regulatory authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. Additionally, due to the excessive slopes, the toe of the component must be inspected a minimum of once annually for seepage. Refer to the "reports" section of this agreement for filing requirements. REPORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. COMM 83.33, Wisconsin Administrative Code. - All piping to tanks and pits shall be disconnected and the abandoned pipe opening sealed. - The contents of all tanks and pits shall be removed and properly disposed of be a Septage Servicing Operator. - After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or other inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system. o A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure(s), lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. o A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. o The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ✓ Mound and At -Grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OF OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE, I Page 10 of 10 f Wisconsin Department of Commerce SOIL EVALUATION REPORT Page__ — of Division of Safety and Buildings in accordance with Comm 85, Ws, Adm. Code County Attach complete site plan on paper not less than 8 12 x 11 inches in size. Plan must include, but not limited to: vertical horizontal reference point ( , i Pa cel I.D. percent slope, scale or dimensio , o row, and location and istan Oa '70 AI Plea a pnn i o ion. p� q�/ R iewe y D Personal information you provide may b for sec oses (Pri cy LaWI k� IS.A4 (t ( d Property Owner S– G". Lot 1/ 1/4 S T 1,V N R $� W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# City State zip Coder Phone Number O City O Village G&Town Nearest Road Sy SY1 /�> 5Z3�o3ga c 3/s 4� SQ�- New Construction User Residential / Number of bedrooms Code derived design flow rate y�� GPD O Replacement 0Public or commercial - Describe: Parent material ;S5 f Q'S i or � �✓~ Flood Plain elevation if aI5plicable /v ft• General comments r �l l a��. ��ll de Q {n J Q / `► � l/" v and recommendations: C /0 U 2 Boring {� Boring # Ground surface elev. 9 3 ft. Depth to limiting factor Z� m• Pit Soil APDlication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •E GPD in. Munsell Qu. Sz. Cont. Color Gr, Sz, Sh. Z �Z C* y 3 lZjz y h� � Y �t oa ,t., 5� r,� z.. ©•� o� Q a Boring # Boring O pit Ground surface elev. V � ft. Depth to limiting factor zd f - Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ro z s �Y �nYn`� s / + , 56k ftll -�- s o�� �• ,3 ly Zo fvYn. � 2r�►.5� ,,�- s Z�I o� ^ a 0/ ; ��� � F� 'Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L S CST Name (Please Print) el t ign tur CST Number Soil Testing g Address emlOCk Rd. Date Ev luation Conducted Telephone Number Mpndovi WI 54755 -8145 7 Property Owns / Parcel ID # Page of Z a Boring # ❑ Boring // , Pit Ground surface elev. ( ft. Depth to limiting factor -G t7 if? . S Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color A Gr. Sz. Sh. 'Eff#1 I 'Eff#2 .* z n 61 c z �y ( / bVL Y7 5 nw� zo 9 V sc c h�-. l ( Gv-z o-3 ;33 `b - rym 3 � 5` - �s gs r�►. ❑ G� Boring Boring ✓ g i Pit Ground surface elev. ft. Depth to limiting factor Z 3 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2 o -? oY43 a r= )tom. 2j'sbk t.--V �, z-�� o�c o.e z �a3 oKn. oao - 'Z'Pobk nwL I ZIA v $ 3 �3� D l2 vt oq w. 2�s6 r,�.G - 2��r 3'30 zbr3� /oY2 6 3 ra►ls`r2 / 1 5 S a� ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. F El pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8370 (807100) C��� �Z3 —o3Ssa p �►ol Zo 3 gn �ro�s 107 P l0,3 d 03.0 ��' sea ►� e c�ro.cL Mll Heidt 4 - gob to Soil Testing Service W 3503 Hemlock Rd. Mondovi Wl 54755 -8145 (715) 832 -0020 ZV, zoo 6 8 26857 r/ KATHLEEN H. WALSH State Bar of Wisconsin Form 1 -2003 REGISTER OF DEEDS ST. CROIX Co., MI WARRANTY DEED RECEIVED FOR RECORD Document Number Document Name 06/06/2006 01:15P1y WARRANTY DEED EXERT # THIS DEED, made between John G. Sauers REC FEE: 11.00 ("Grantor," whether one or more), COPYSFEE: 148.50 and Michael G. Market u. 5 � Vw le Mat•l CC FEE: PAGES: 1 ( "Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ( "Property ") (if more space is Name and Return Address needed, please attach addendum): Martha Plante The RiverBank P.O. Box 188 Part of the NE r /4 of the SW '/ of Section 2 -28 -15 described as follows: Lot 1 of Osceola, Wisconsin 54020 Certified Survey Map recorded October 24, 2003 in Volume 17, Page 4637 as Document No. 744752. 004 - 1003 -90 -100 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: easements, restrictions and ordinances of record and will warrant and defend the same. Dated May 30,2006 (SEAL) x (SEAL) * *J ohn auers (SEAL) Z (SEAL) * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) authenticated on ) ss. • POLK COUNTY ) * Personally came before me on May 30, 2006 , TITLE: MEMBER STATE BAR OF WISCONSIN the above -named John G. Sauers (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and ackiWwledged the e. THIS INSTRUMENT DRAFTED BY: Priscilla R. Dorn Cutler Osceola, Wisconsin 54020 Notary Public, State of Wisconsin My Comm►ssionrti!r mei}t) (expires: !/ — f- 20 0 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 1 -2003 * Type name below signatures. 1 of1 05/31/2006 15:04 7152352592 T L SINZ PLUMBING PAGE 03/03 ST. CROFX COUNTY SEPTIC TANK. MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address S� 3� s +h �� �— ��n5 L-1 Vy?7 Property Address 31 s + '- 2- (Verification required from Planning & Zoning Department for new construction.) City /State k' J Parcel Identification Number C0 4 / - /t-' 3 0 3- J/0 -/ 00 LEGAL DESCRIPTXON PrOPerty Location 1t/ r/, , Stv V4 , Sec. _`� , T -q '� N Rj W, Town of C44' Subdivision Lot # Certii ied Survey Map # '7 yy7 5 Volume 17 , Page # q07 Warranty Deed # Volume Page # _ Spec house yes Lot limes identifiable no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result m its premature failure to handle wastes. Proper maintenance consists ofpumping out the septic tamp every three years or sooner, if mceded, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal systems. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St Croix County Sani ry Ordinance. The property owner agrees to submit to St. Croix County Planning & 7rmimg Department a certification form, signed by the owner and by a m seer plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on - site waatewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersiped have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, asset by the Departrment of Commerce and the Department of Natural Resources, Statc of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to tbie St. Croix County Planning & ,Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my /our knowledge. Vwe amlare the owner(s) of the Property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms C am — Co / SIGNATURE OF APPLICANTS) DATE ** *Amy information drat is misrepresented may result in the sanitary permit beimg revoked by the Planning &.Zoning Department. * "* Include with this application a recorded warranty deed from the R reference is made in the warranty deed, egister of Deeds Office and a copy of the certified survey Hasp if (RE 08/05) - 7 , c+ 4 7 5 2 VOL 17 PAGE 4637 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 10/24/2003 10:30AM CERTIFIED SURVEY MAP COPY FEE: 3.00 PAGES: 2 CERTIFIED SURVEY MAP LOCATED IN PART OF THE NORTHEAST 1/4 OF THE SOUTHWEST 1/4 OF SECTION 2. NOTE' TOWNSHIP 28 NORTH. RANGE 15 WEST, TOWN OF CADY. ST. CROIX COUNTY. WISCONSIN. 3 BEARINGS ARE REFERENCED TO FOUND 3" ALUMINUM I CD I - THE NORTH - SOUTH QUARTER COUNTY MONUMENT o rn LINE OF SECTION 2, MEASURED NORTH 1 4 CORNER � UNPLATTED LANQ� / I o ASS 00'00'08' W. (ST. CRgX SECTION 2, T28N, I I CD COUNTY COORDINATE�• t/!•••••••.•:ORTH LIN N 89"1 '45 " 1318.94'T'HE SW 1/4 R1 5W fl IN ......,.,� I� 1297.80' 21.1 �F�� . I ROGER HtA1AEY APP1Z0 a I C" I � PHR � S -2188 � LOT 1 ST. cxtotx w j � I � I v`''i W OOO\ALLE 6 13.79 S. F. PbnnW4 7cw*m x ,„ 1 P ft CoR• -Vm 3 1 I rr 13.79 Ac. • t .gip INCLUDING R -O -W OCT Z 4 a ' "' �►� 590527 S.F. o \ 13.56 Ac. O I EXCLUDING R -O -W $ ` s a• If not tsoorOed vv(Urin 30 days of I l $ 3 approval defaPprovEd tm b I N I N / rwdl prrd void ' I i 1 23.1 1 wN N 8853'28" E 864.77' 429.95' �� 411.67' 453.10' N 89'45'51" W 453.10' I I I z Im z n JI Drill I QI `" N 3 L°i' 1311 I � I 0o LOT 2 o M LOT 3 - a k� i 263199 S.F. �o r` 332389 S.F. iA a_. n.l 2 263199 6.04 Ac. w 7.63 Ac. c N N N Iq ° I I�'I I Q S 89'45'51" E 454.75' { I � P; S 89'30'14" o° 429.95 24. O_ - v� 125.00' I o_ z Ln I I LOT 4 I C5 166486 S.F. z M 3.82 Ac. Y I 3 I 13 I 3 ¢I INCLUDING R -O -W ¢I I N oI „' O � 157294 S.F. °D In I ;O I � ° o cv o 3.61 Ac. owl orl �QI D I m 50' HIGHWAY o 50' HIGHWAY ° N SETBACK LINE Q >? N EXCLUDING R -O -W oI Ig I - -_ - - -- $ oI SETBACK LIE N - - - -- tn SI Z 442.94' — — — — 4 698• — - - - - -- - S 89 3 0'1 4" W 2 83.00 — 881.55' io r4 _ _ a0 L (D (Z gp AvErrI1E ��S'3a'L4'rW 367?32' - ` 0 ;,� - — — n — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — n — — — — — FOUND 3" ALUMINUM OWNER LtrJ3MSWA7TL9A COUNTY MONUMENT, - SURVEY CONDUCTED AT THE LEGEND: SOUTH 1/4 CORNER N REQUEST OF THE OWNER: SECTION 2. T28N R15W • FOUND 1" IRON PIPE 3900 JOHN G. BLE RS a SET 3/4" BY 18" IRON MINN PE OLIS M OOK DRIVE PIN Wf 1.50 LBS. T. MINNEAPOLIS MN, 55437 � COUNTY SECTION MONUMENT (FOUND AS NOTED) DOT APPROVAL # 55 -94- 3686 -2003 NOTE: 0 w w "CAUTION - HIGHWAY SETBACK RESTRICTIONS PRCHic!T IMPROVEMENTS. SEE SHEET 2." THIS INSTRUMENT DRAFTED BY ROB OHMAN SHEET 1 OF 2 Vol 17 Page 4637