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Computer #: 004 - 1018 -80 -000 Parcel #: 08.28.15.1286 Municipality: Cady Township Address: 418 290th Street Wilson, WI 54027 0310312003 4201 Jon Sonnentag I received the following email: Jon, I don't know if you recall this issue but there is more, since the fall or so my mom noticed water near the cement tanks. I recently went to take a look it appears that near the tank that has some settling that I mentioned to you has waste bubbling up out of the ground now. I believe we �tj v now have a problem. I just received a call this morning from my mom the sewer is now backed up in the house. This appears to be a failure in the system . You must know by now we are not a bunch of happy campers. We want action taken and something done at this point I'm sure you understand . Rogers plumbing makes himself scarce and difficult to reach this is frustrating. We have never had sewer problems since the old one was put in, that's been 40 years. My mom has made a call to Rogers this morning it will be interesting to see what excuse he has this time . Please look into this . Thank you, Steve Rositzki home 684 -5433 mobile 612 - 578 -1157. �.n .w �:, ,..N� < >..�. „: ,...... "�"' W �.. �.'�.. + "'t....'A.'",, brG. +. .XT. a': - 4P'l,� � s✓'+:. ..' "8',.L`�' ' f�j' ., ... e..�.. , C _1r."l,. i i if / M `('' ✓ � f � � r -.a J ? a ' Stu ,..,:.:• a t L ' it w. 3 /1-7/6 Jam- Computer #: 004- 1018 -80 -000 Parcel #: 08.28.15.1286 Municipality: Cady Township Address: 418 290th Street Wilson, WI 54027 0510712002 4201 Jon Sonnentag He explained that it appears that the tank is starting to tip in one direction. He has contacted the plumber and they stated that it would cost about $1000 to correct the problem. l explained that there are bedding requirements and they should be liable if they didn't complete that. I will send him a copy of the code and get a hold of Mike Rogers. 0510812002 4201 Jon Sonnentag (email) Steve I have been searching through the code up and down and have discovered that they have removed the requirements regarding bedding of septic tanks. Under the previous code section 83.16(4)3.(c) stated that "a 3 -inch thick compacted bedding shall be provided for all septic and other treatment tank installations. The bedding material shall be sand, gravel, granite, limerock or other noncorrosive materials of such size that 100% will pass a 112 inch screen." Unfortunately this section no longer exists. I have spoken with the plumber, Mike Rogers, and he stated that he will try to stop by on Friday to see what problems might exist. Some settling should likely be expected around that tank, but not to a point where it will affect the operation of the septic tank. Mr. Rogers will get back to us regarding his findings and may have us visit the site with him. If you have any questions please feel free to contact our office. Jon Sonnentag 0510812002 Rogers, Mike Jon Sonnentag He is not aware of any major problem. He will try to swing out there on Friday and take a look. 0510812002 4201 Jon Sonnentag Left a message for him that I was not able to send him an email. 0611112002 2330 Jon Sonnentag Left a message that I was returning her call. 0611212002 Rogers, Mike Jon Sonnentag Left a message for him to return my call. 0611212002 2330 Jon Sonnentag She does not know if hike Rogers was out there and she has not heard from anyone. She explained that she already had to pay an additional $1000 to have the landscaping improved on the mound so it wasn't just rocks and sticks. I told her I would contact Mike. Computer #: 004 - 1018 -80 -000 Parcel #: 08.28.15.1288 Municipality: Cady Township Address: 418 290th Street Wilson, WI 54027 03/03/2003 3636 Jon Sonnentag Proper bedding is no longer covered in Comm 83. However, as part of each tank approval under Comm 84, the manufacturer is suppose to indicate the bedding and backfilling requirements. Be aware that the natural soil could have been used as bedding material. The primary purpose of the bedding is to protect from damage caused by a cobble or stone that may be lying a fraction of an inch below grade. It is also easier to level loose bedding and to form it in the manner prescribed by the maufacturer. If we cannot attest to the bedding at the final inspection then I believe that you are correct in assuming it would be difficult to prove the bedding was defective. The problem you described ( i.e. leaning manhole riser) leads me to suspect that the cover or sidewall of the tank could be about ready to collapse. NO ONE SHOULD ENTER THE TANK. If sewage is surfacing at the tank and then backed up this could be related to a partial collapse. Can't say much more at this time. 0310312003 Rositzki, Steve Jon Sonnentag Apparently someone from Rogers Plumbing will be coming out. I explained that there is probably nothing we can require from the plumber at this time, but we would be willing to swing out to observe the situation if they decide to remove the soil from around the tank. 0310312003 3636 Jon Sonnentag Leroy There was a situation last summer where an individual called to complain about the fact that their manhole risers appeared to be leaning towards one direction and that the area around the septic tank had settled some. There was nothing on the inspection report that indicated that a potential problem could exist. The plumber indicated that he would go assess the situation and we have heard nothing since. Today I received the email below and depending on the severity of the failure, I suspect there could be some legal ramifications. I assume the plumber has responsibility to avoid creating this situation even though I was never able to find bedding requirements in the code. Is there a section in the code that would address this situation. I believe this is probably a problem the property owner will have to resolve under their own direction. I don't believe there is any action we can require from the installing plumber because at this point we can't prove that the problem was created by an error made during installation. if and when repair work is needed, we could be present to observe if there was inadequate bedding. However, our observations would just be supporting evidence for any legal action the property owners wishes to initiate. We'll try to visit the site once the snow melts, but I don't think we'll be able to become actively involved in this situation. Would you agree with my assessment of this situation. Jon Sonnentag W It sc - cry V4 s i tsep®r nent■of-- gomm,',ye PRIVATE SEWAGE SYSTEM Coun St. Croix Safe nd Bltildin Division - ., INSPECTION REPORT Sanitary Permit No: 399472 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)]. — 7 - 9*W. IDA Permit Holder's Name: City Village X Township Parcel Tax No: Rositzki, Marie I Cady Townshi p 004 - 1018 -80 -000 CST BM Elev: �� Insp. BM Elev: BM Description: W- I w-0 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 2.0 6b � J Dosing ' ` 3 ,d /� 1 t Alt. BM Aeration "" (-�,� Bldg. Sewer ii pX . 83' Holding St/Ht Inlet boa l r TANK SET CK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic t / 1 4 , _ Dt Bottom /3.3 Dosing N « a i Header /Man. t 1 � 9 2, L f � 2, '30 Aeration Dist. Pipe Z, ZZ • Z I 10Z. - 30 , Holding Bot. System e PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover 4t GPM Model Number 6� T H Lift Friction Loss System Head TDH Ft Z •s Forcemain Lengt f Dia. ti Dist. to well t 3} SOIL ABSORPTION SYSTEM W idth Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS O t 7 f SETBACK SYSTEM TO P/L JBLDG WELL LAKE/STREAM LEACHING ufact INFORMATION CHAMBER OR Type Of System: _ � # 5 J 1 1 — 9 0 ^� UNIT odel Numbe . DISTRIBUTION SYSTEM .0(►_ L A. PL • — e:,,,,d� Header /M ifold i P iptr(b) lion I 11 I x Hole Sae // f1 x Hole Spacing of Vent to Air Intake Lengt Dia Length .Dia 2 Spacing �^ //b 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 Depth Over Center Bed/Trench Edges Topsoil 1 IN-1 Yes ❑ No ❑Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) In ecti n #1: 10 / 19 / O1 Inspection #2: - -- -* --r �� IrP.w 4� Location: 418 290th Street Wilson, WI 54027 (SE 114 SE 114 8 T28N R15W) NA LotMi _ �e1 08.28.15.12813 1.) Alt BM Description = AI/A T> � ( air 10 1 . 42' `S Wit- Z. f� ��rT 1 2.) Bldg sewer length = - 9 3Q 1 l� ` ^j ��- �'"` & �. d.� 12 - amount of cover = 2 p (r + Plan revision Required? ❑ N Use other side for additional i orm�J CIO Date Insepctors Signature Cert. No. SBD -6710 (R.3197) y { j Safety and Buildings Division County o V Aw 201 W. Washington Ave., P.O. Box 7162 - , jsconsio Madison, WI 53707 - 7162 Site Address Department of Commerce �� Z�10' sl/_ze_� Sanitary Permit Application Sanitary Permit Humber In accord with Comm 83.21, Wis. Adm. Code, personal information yoq pfovide 11 Check if Revision 3qq q7-0- may be used for second Privac Law si5.04(1)(m)"' -.;; I. Application Information - Please Print All Information 0 State Plan I.D. m 8' C. Property Owner's N O ame , Parcel Number Man RQST±l Property Owner's Mailing Address Q Property Location r (� 1 � Qr 3E'k E'k:S 8 Tg N,R I i J City, State Zip Code �; ` , PhoniLdVRer Lot Number Block Number ism .ti Subdivision Name CSM Number H. Type of Building (check all that apply) n fit, ❑City X , or 2 Family Dwelling - Number of Bedrooms _ '4 � rco I I y� L ❑Village ❑ Public /Commercial - Describe Use Townshi ❑ State Owned Nearest Road III. Type of Permit: (Check only one box on ine A (numbering scheme for internal use). Complete line B if applicable) A. 1 ❑ New 2 Replacement System 3 11 Replacement of 6 ❑ Addition to For County use System Tank Only Existing System B. ❑ Check, if Sanitary Permit Previously Issued Permit Number D IV. Type of Permit: (Check all that apply)(number , ,Wig scheme is for internal use) ZO C /O S�. 44 11 Non - Pressurized In- Ground 47 11 Sand Filter 50 11 Constructed Wetland 22 - Ground 41 El Holding Tank 48 El Single Pass 51 ❑ Drip Line .4w 45 At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other rentment Area Information: U,n,J w /o/, to Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals. /Days /Sq.Ft.) (Min. /Inch) 4011. Elevation �w a o vv I S 74P1 �4_ / 03. Z VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Holding Tank Dosing Chamber A W VII. Responsibility Statement- I, the undersigned, ass4me reap i lit for insta llation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Si P /MPRS Number Business Phone Number 611AL 1 2 ,: 260 941 7/6-e�2W712� Plumber's Address ( et, City, State, Zip C e) ff 44L a VIII. County !De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee includes Groundwater Date Issued Issuing Agent Siignapree (No Stamps) C3 Owner Given Initial Adverse . Surcharge Fee) Determination I IX. Conditions of Approval/Reasons for Disapproval 1. The existing system must be abandoned per code requirements. 2. Effluent filter to be installed and maintained per manufacturer's recommendations. . 3. Floodplain mapping = Zone "C" 4- All setbac to system and residential structure must meet applicable code requirements. 5. Well Set acks to be MNWaa fPll'> ItW9 1 1 t &Woly only) for the system on paper not less than 81/2 x 11 Inches In size S 6. Wisconsin Fun st e. Wvu. 1 w►,Futto St' • S6 -S�� g -2..52 -�s' w vim S �� ��� : ��� lq.r,' fi t" f'uC (�t4 � � 1 11 � .. Wryer' R �S= �.s�r(n�► � t tam- -4-4-o 1 �``' Q4ft C16- \0 0 +3 b o. cl��n e Q �4 D Y •tXl 4� � Q.v I Z' * 1 L p Y� g C. ►� IQs,; C 3 a� g 4 ORIGINAL. 1354 Wisconsin Department of Commerce SOIL EVALUATION REPORT page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Certified Soil Testing ounty Attach complete site plan on paper not less than 8 %x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 004 - 1018 -80 -000 Please print all information. Re wed Y Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (t) (m)). �® P rope rt y Owner Prope Location Rositzki, Marie Govt. Lot SE 1/4 SE 1/4 g 8 28 N R 15 W P roperty Owner's Mailing Address Lot # Block # Subd. Name or CSM 418 290th St. City State Zip Code Phone Number Cit Village a Town Nearest Road Wilson WI 54027 715 - 772 - 3185 Cady 290Th St. 2d New Construction Use: gi Residential / Number of bedrooms 4 Code derived design flow rate jN Replacement Public or commercial - Describe: Parent material till Flood plain elevation, if ap Nable �'� ~ NA ^ General comments ...n� and recommendations: install 10' x 120' effective (12' x 120' overall) rock unit at -grade system w/ laterals i ollowing 141.6 contour . F -9 Boring # N Boring gi Pit Ground Surface elev. 98.8 ft. Depth to limiting factor 22 in. ,toilApplication Ratk Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0 -3 10YR 3/2 - sl 2 m gr ds cs 1f /m .5 .9 2 3 -10 10YR 3/2 - sl 2 f sbk ds cs if .5 .9 3 10 -22 10YR 4/4 - sl 2 m sbk dsh cs if .5 .9 4 22 -34 10YR 4/4 c2p 7.5YR 4/6,5/3 sl 2 m sbk mfr cs - .5 .9 5 34 -39 7.5YR 4/4 - s 0 sg ml cs .7 1.2 6 39 -45 7.5YR 4/4 c2p 7.5YR 5/8,5/3 sl 0 m mfr - .3 .4 F YI Boring # Boring 0 Pit Ground Surface elev. 101.6 ft. Depth to limiting factor 38 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0 -3 10YR 3/4 - sl 2 m gr ds cs 2fl m .5 .9 2 3 -8 10YR 3/4 - sl 2 f sbk ds cs if .5 .9 3 8 -15 7.5YR 4/4 - sl 2 m sbk dsh cs if .5 .9 4 15 -30 7.5YR 4/4 - sl 3 m sbk mfr cs if .5 .9 5 30 -38 7.5YR 4/4 - s 0 sg ml as .7 1.2 6 38 -48 7.5YR 4/4 c2p 7.5YR 5/8,5/3 sl 0 m mfr - .3 .4 - T - i -1 . I � I ' Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BO D < 30 mg /L and TSS < 30 mg /L Name ease rent ign ure: U61 Number Henry F. Grote 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 7/20/2001 715- 233 -0398 a Property Owner Rositzki, Marie Parcel ID # 004-1018-80-000 Page 2 of 3' Boring # Boring Pit Ground Surface elev. 101.0 ft. Depth to limiting factor 59 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0 -4 10YR 3/2 - sl 2 m gr ds gs 1f /m .5 .9 2 4 -11 10YR 3/2 - sl 2 f sbk ds cs 1m .5 .9 3 11 -22 7.5YR 4/4 - sl 2 m sbk dsh cs if .5 .9 4 22 -28 7.5YR 3/4 - Is 0- sg dl cs - .7 1.2 5 28 -46 7.5YR 4/4 - s 0 sg ml cs - .7 1.2 6 46 -59 7.5YR 4/4 - Is 1 m sbk mvfr cs - .7 1.2 7 59 -62 7.5YR 4/4 c2p 7.5YR 5/8,5/3 sl 0 m mfr - - . 3 .4 ❑Boring # WA Boring jg Pit Ground Surface elev. 101.6 ft. Depth to limiting factor 38 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz, Sh. 1 0 -3 10YR 3/2 - sl 2 f sbk ds cs 1f /m .5 .9 2 3 -8 10YR 3/2 - sl 2 f -m sbk ds cs if .5 .9 3 8 -15 7.5YR 414 - sl 2 m sbk dsh cs if .5 .9 4 15 -38 7.5YR 4/4 - s 0 sg ml cs - .7 1.2 5 138 -44 7.5YR 4/4 c2p 7.5YR 5/8,5/3 sl 0 m mfr - - . 3 .4 i horizon 4 has occasions inclusions Is + strati fie 5/ s an s: 4 dipping about'30 degrees about' to south Boring # Boring Pit Ground Surface elev. N95.7 ft. Depth to limiting factor 15 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0 -5 10YR 3/2 - sl 2 m gr ds cs 1f /m .5 .9 2 5 -15 10YR 5/4 - sl 2 m sbk dh cs 1m .5 .9 3 15 -30 7.5YR 4/4 c2d 7. 4/6 10YR sl 2 m sbk mfr cs if .5 .9 6 6/2 4 30 -34 5YR 4/4 f2d 7.5YR 5/3 sl 0 m mfr - - . 3 .4 I existing "system" is ategory 1 re y Wl Fund standards Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L * 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 -8330 (R.07 /00) Certified Sal Testing a.�.• � d s �. 1 �t ut.lol .•• d.�Q w :�t v C, h 3-1 � Q. S.St w..�� —�-• w a sS - AIG �.uw �c (( (t uv • J Q % a+v r T .. u .. i .1 l; •.. 1 .-� 1 T d�.►..•.. CL NL cry �1 �ru .tl � C1d4.t� `� t .S b w c1�� 0 2 �l - r �RX/ Jw� t: •4 I Q.v C �� CVS ` Safety`and Buildings t r'. 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TD #: (608) 264 -8777 Visconsin www www•commerc . o nsin. ov .wiscnsin.gov Department of Commerce Scott McCallum Governor Philip Edw. Alba 9 pr September 21, 2001 CUST ID No.225094 A7TN: POWTS Inspector ZONING OFFICE 5T MICHAEL P ROGERS ST CROIX COUNTY SPIAtNGd�� N4563 320TH ST 1101 CARMICHAEL RD i MENOMONIE WI 54751 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/20/2003 Identification Numbers Transaction [D No. 674836 SITE: Site ID No. 635808 Marie Rositzki - 418 - 290` Street Please refer to both identification numbers, St. Croix County, Town of Cady above, in all correspondence with the agency. SEl /4, SETA, S8, T28N, R15W FOR: Description: Four Bedroom At -grade System - Individual Site Design Object Type: POWT System Regulated Object ID No.: 811263 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. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans and with parts of the "At -grade Component Manual Using a Pressure Distribution System for Private Onsite Wastewater Systems" SBD- 10570 -P (8.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD - 10573 -P (R.6/99). • 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. Slats. Owner Responsibilities: • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the at -grade component manual are complied with. A copy of the instructions and information regarding proper use and maintenance of the system must be given to the owner and each subsequent owner upon completion of the project. • The activities relating to evaluation and monitoring mechanical 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. MICHAEL P ROGERS Page 2 921/01 • 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. 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 fo 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. Sincerely, FEE REQUIRED $ 300.00 FEE RECEIVED $ 300.00 BALANCE DUE $ 0.00 Gerard M. Swim POWTS Plan Reviewer - Integrated Services 608 - 789 -7892 Mon - Ffi 7:15 AM to 4:30 PM WiSMART code: 7633 jswim@commerce.state.wi.us cc: Marie Rositzki Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 MD #: (608) 264 -8777 �scons�n �� www.commerce.state.wi.us/sb www.vAsconsin.gov Department of Commerce ) 1� Scott McCallum, Govemor Philip Edw. Albert, Acting Secretary September 21, 2001 CUST ID No.225094 - - - - -" r A7TN: POWTS Inspector ZONING OFFICE MICHAEL P ROGERS ST CROIX COUNTY SPIA N4563 320TH ST 1101 CARMICHAEL RD MENOMONIE WI 54751 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 09/20/2003 Transaction ID No. 674836 SITE: Site ID No. 635808 Marie Rositzki - 418 - 290 Street Please refer to both identification numbers, St. Croix County, Town of Cady above, in all correspondence with the agency. SE1 /4, SETA, S8, T28N, R15W FOR: Description: Four Bedroom At -grade System - Individual Site Design Object Type: POWT System Regulated Object ID No.: 811263 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. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans and with parts of the "At -grade Component Manual Using a Pressure Distribution System for Private Onsite Wastewater Systems" SBD- 10570 -P (8.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD - 10573 -P (R.6/99). • 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. Staffs. • 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. Slats. Owner Responsibilities: • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the at -grade component manual are complied with. A copy of the instructions and information regarding proper use and maintenance of the system must be given to the owner and each subsequent owner upon completion of the project. • The activities relating to evaluation and monitoring mechanical 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. l MICHAEL P ROGERS Page 2 9/21/01 • 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. 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 Co 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. Sincerely, FEE REQUIRED $ 300.00 FEE RECEIVED $ 300.00 BALANCE DUE $ 0.00 Gerard M. Swim POWTS Plan Reviewer - Integrated Services 608 - 789 -7892 Mon - Ffi 7:15 AM to 4:30 PM WiSMART code: 7633 jswim@commerce.state.wi.us cc: Marie Rositzki t Marie Rositzki - At -grade System Transaction # Construction Materials and Techniques All materials must comply with Comm 84 and be installed in accordance with manufacturer's specifications. Construction methods must comply with the following Component Manuals: Individual Site Design Concave At -grade Pressure Distribution, SBD- 10573 -P (6/99) Location: SE 1/4, SE 1/4, Sec. 8, T 28 N, R 15 W Town: Cady County: St. Croix Date: September 5, 2001 Owner: Marie Rositzki Address: 418 290th St. Wilson, WI 54027 Plumber: Mike Rogers Signature: r License # MP 225094 Attachments: 6748 -Plan Approval Application SBD -8330 page 1: cover RECEIVED 2: design criteria & calculations 3: plot plan SEP - 5 2001 4: plan view, system cross section 5: lateral detail sway & BLDGS DIV. 6: pump tank exit detail 7: pump curve P.O.W.'T.S. 8: system management Conditionally APPROVED DEPARTMENT OF COMMERCE page 1 of 8 DIVISION Of SAFETY AND BUILDINGS, SEE CORRESPO. NCE Design Criteria Residential Wastewater Contaminant Load: 30 mg /L < BOD < 220 mg /L Anticipated septic tank effluent 30 mg /L < TSS < 150mg /L Fecal Coliform > 10,000 cfu/100 mL Fats, oils, grease < 30 mg /L Bedrooms x 100 gal/bedroom/day x 1.5 v-o gallons /day hydraulic load Design Calculations In situ designed loading rate gallons /sq. ft. per day Depth to estimated high ground water in. Depth to bedrock ' 6 z in. Cross slope at system 1 9. sr % Oft Force main length k Ot o ft. of Z in. Manifold /header length %-A Or ft. of — in. Drain -back 3 gallons r Lateral length 21 @ S ° I •© ft. of --;a' a in. Lateral elevation Z ft. @ bottom of lateral Lateral hole size 3 ��b in. @ in. ( 2•o ft.) Spacing 30 holes /lateral 6 holes total Lateral volume °' %-b gallons Total lateral discharge rate 3 • b gallons /minute @ �• S� ft. head Network pressure compensation losses ft. Elevation difference 12 •��� ft. Friction loss ft. @ gallons /minute Total dynamic head 2 �' gZ ft. Pump /si*n Ss�' gpm @ Z ft. of head Manufacturer ` `^���►� Model # Dose volume b gallons Lift /sip>on tank 4 - "•S'O t VM co— gallons Septic tank gallons Effluent filter Measurement pump on and off S ' 3 in. Height alarm from tank bottom 3.3 in. Reserve capacity s�°l gallons specs calcs.res Page of g � � U•a-• 2. 1 �. c� S, � �.1c. , .. ,� 1 d �r , .r.,� �� �` .3��. O �� �l'' L a., S G� e S GN TL7 YY YC.Q WwV+� M Q� I ( •. q a.(.) -Sri* Q Q q ir QNb;a� Jr.� � 1.'"•' 'y7 �u a4� d ` OK roeX�i- e .JGQ.v ((�� � r ( �, /1�.�� G.OkawQ \ 4 y.: � �+/ Z. � a Y►� h \tcw 1 4. i \.wc -L- X2.M.7UQa.i ip�`ogn 1 0�.b t- r'►rO"M C� P---. � L s \ moo' •� l .1 4, S: 3 a� g Pv vC- LL- �•�, I I 2. d' I t.p' t.o' � Z.O� I Z.a7' I 11 II b'2S L-A N�AA CSL.%.TQj6- � G h V...A� ct n I r 5� 5� VL J 1t.o' I IA. 2' obso....,J:� 4 Svc. 1�•. \��.�..� ��....., _ � Fabric Distribution Lateral Observation ��- Soil Cover W e l l 12 2 ' ++ L 5,0� 10.0' -- ZZ. O' F r. FotLl.r" TG I MJEATIIERPQOJF LOCKIWG�COWER .TuNaioH Boot 4'w/ /V" 4 ,48EZ . QUICK D�aCOyWCT --� ,•. g 6 4 p , j c 5�� 4 p Plv� 3' Yl"0 NoIST SOI 2 4w I.D. I 4 �o YJsIJT MKAHu01E K 4r • � ��W(IP pWa.wrs.D A UET =Wr5 _._.� WFL6 .1.. aL 3' owTo �rwECTlOt�b �- ('�.1•.�.JL N ` ,' GROU►ao C �.�.,, - e�ocK • get SEPTIC E __PE G I t: I OfJ S c� DOSE TAWKS MA►JUFACTURG `--V •+�lih (JUMSER OF DOSES: PER DAB TAWK SIZE : GALLOWS DOSE VOLUME ALARM MAAIUFACTURER: S - E F\'.a•vro INCLUDING 6ACK /LOW: (,ALLOt�S MODEL LIUMDCIR: I ° 1 Nw CAPACITIES: A= 34•'A IIJCHES OR sr�t -4r GALLOIJ5 SWITCH TUFL: W° � � 4Lwv z .,lb 5 . Z IAI C H E5 OR �Z•Z GALL0kJ5 PUMP 1'AQUFAC R TUCR: � °`"•Oi��° C ■ '541. IIJCHES OR GALLOW5 MODEL AJUMDER: D INCHES OR GALLOuS SWITCH TYPE: �no.�.a..` "'O MOTE: PUMP AMD ALARM ARE TO DE MIMI MUM DISCKAR" KATC _GPM INSTALLED OW 5EPARATE CIRCUITS VERTICAL DIFFEKEIJCC BETWEEIJ PUMP OFF AI,JO DISTRIbUTIOAJ PIPE.. �Z •3�i FEET 4 + MIWIMUM WETWORK SUPPLY PKt&6LJItE + klq%D FEET OF FORCC MAIN X 3 __ 3 F X00VtFKICTIOIJ FACTOR ( '' Z FEET �° = TOTAL DyWAMIC• HEAD = � 1 '�� FEET IWTERWAI DIMEW61OWfi OF TAWK: LEW&TH...___, ;LIQUID DEPTH P qL•� 6 �F '8 ENGINEE D ETAILS 1 00 Performance Data 30, 100 Pump Characteristics 74 80 Pump/Molar Unit Sabtnectdwe j Moeuol Medelt'SO M1 r1S2 M3 M4 MS SHEF100 ActeeNtk Models Al A2 18 s 60 New wa 1/2 Full teed k!21 15.0 7,617.1 3.1/3.11 1.6 1 1.2 0 Mat« t 40 to pro, Start 3 0 =1 SHfF50 R.P.M. 3450 i ...... �..._.. ......;�. Phone ' 6 36 Vohage I15 1G8.2J0 M-2301460 575 4� 24 ....._. I Memol Model 000 M2 M3 1 M4 MS Aul—flc Medals A2 Full lwdAm s r s.t, u.t s.eisa 2.B 1.9 Capacity -U.S. G.P.M. G 20 40 60 80 100 Mot« t Co eater Start 30 _..._._ .— RPM 3430 lilers/Sesttrd 0 2 4 6 Most i 0 30 Told Neat (fat) 16 25 35 45 5S b5 T5 90 Yalt a 205 -230 205.230 460 STS — — Neru 60 _.� l OJ 13.7 16.8 14.8 22.4 • 21 Topnitemitire 140` P Mate FIUU rate . 1/2 HP (US GPM) 63 55 41 35 18 —• — N1h4A Oeti n 1 l (I /s) 4.0 3.5 i 3.0 2.2 1,1 --- - — - — teswetlon pass B 1 HP (US GPM) $1 81 14 65 50 32 0 ' Disd"r a Site 2" NPT Std. - (I /s) — 3,5 1 S.I 4 . 1 1 4,1 3,2 Scilds Nand si 3/4 Unit Weight s86s.cso) I 6slbs.I100) Dimensiona Data Porter Cord 1 14/3, S)TWA; 230Y, la, 16/3 STW -k 3a 16/4, STWA 1 All dirnenaions+ in incnas. AN cords 20' std, with 30' apt, 2. Component dimrinbsons may vary +1. 118 inch, I 3. Not tar construction purposes unless r smf" Materials of Construction 4 Dimensions and weights are approximate. B. Wo irmirve the right to make revisions to our products and thoir "slide Stssinlesssteel specifleatlens wuhou; )utioe. E. noatt switch (auinmmic models only) „w'` Lubricating dl DieleRru 011 Motor housiaii Cost Iran Pump Casing ease Iros ` Shaft Stowess Steel I Methe"ai Seal Facer. Carbon /Carataic Shell Seal Seel Body: Brass Sprteg: Sraedeis Sled u n Bellows: bugs -N Wpelor 6ylnarer Thrmapiestie r+i neuuea I i Upper Bearing Single Row hill BeWag i tower Bearing SinBb Row lull Bearieg I Bottom Plate "oslat Caated Steel ,• i fns Wwrs Slai,tlns Steel ;. _...- .... ( , I togs {ryineered %armpilestk SH6F50 5HEF 100 ,� 1840 Bane Road`' ” CP `� HYDFROMATI Y r r Ashland, Ohio 44805 ./ Tel: (419) 289 -3042 �I � r , ' System Management Management of this system is critical. As a condition of approval of these plans this system management section must be reviewed with the homeowner, and the homeowner must be provided with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber, Rogers Plumbing, 715- 235 -1132, or the St. Croix County Zoning Office, 715- 386 -4680, should be contacted for assistance. General Proper functioning of an on -site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or compartment to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. 1 . If the septic tank is installed prior to sheet -rock and/or painting, pump the septic tank before normal residential use begins to ensure adherence to contaminant load design criteria. 2 Install water- saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. 4. Never pour grease or oil down any drain or stool. 5. Garbage disposals are not recommended; if you must have one, use it sparingly. 6. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. Maintenance 1. The septic tank must be inspected every three years by a properly licensed person. 2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. 3. When the septic tank is pumped, any solids in the bottom of the pump tank must be pumped, and the filter must be back - washed into the septic tank to remove accumulated material. 4. Periodic observation pipe inspections should be made by the homeowner to examine the state of the in -situ soil adsorption cell. Quarterly inspections are recommended, and a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. 5. If this system contains,,specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. 7. Avoid compaction such as vehicle traffic within 15' down -slope of the adsorption system. 8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run -off into the system area. 11. Warning: Do not enter septic, pump or other treatment tanks; death may result because they may contain lethal gases or insufficient oxygen. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for residential systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing, and/or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 SEPTIC TANK MAIT]TENANCE AGP.EE1viENT AND •.. " [ *.1 + }�� OWNERSHIP CERTIPTCATION FORM 0 n� M arlL . J.. i , 1 1 z/C..L � ,- Mailing Address c:L v i(7. Property Address_, (Ve.rification required from Planning Department for new construction) CiryiSiate J A f W � . Parcel Identification Number LEGAL DESCRIPTION ��tt Property Location Y,, J� 1 /�, Sec. TN -RW, Town of Subdivision ___ . Lot # Certified Survey Map # , Volume , Page # Warranty Deed # , Volume , Page # Spec house ❑ yes ❑ no Lot lines identifiable ❑ yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank- every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, jotuneyman pltunber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 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 Department of Natural Resources, State of Wisconsin, Certification, stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office witbi r 30 days of the three year expiration date. SIGNATURE OF APPLICANT DATE ONNNE.R CERTIFICATION I (" certify that all statements on this form are true to the best of my (our) Imowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICA DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include fvith this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed Al eou WT rr ` R 3211:?�tl . A i STATE OF WISCONSIN — Ste mix CH IN THE MATTER OF THE JOINT TENANCY ' i + 0 r IN ESTATE OF _- Wal ter F. Rositski i 1 •l Deceased. - ---- - - - - -- - - - -- -- �n Flu as tein,� � J1 19 r The p etition of Marie Rositski, i p * /w e , tor in Pru:�.,te , for a certificate of the termination of the joint tenancy of _,_ Walter F. Resitski in the property hereinafter described, coming on for hearing; And it appearing that due notice thereof has been given to or duly waived by the Wisconsin Department of Revenue and the public administrator in accordance with law; And it satisfactorily appearing by the verified petition of said petitioner, who is legally interested in said matter, and by the proof submitted, that such certificate may be iss�ted; Therefore, I, - Joe epb_W. s _ County Judge of - - -_ St. reix County, Wisconsin, do certify that Walter F. Rositski died domiciled in St• Croix - -_ County, Wisconsin, on _ November 1, 1969 Decedent at the time of death had an interest as joint tenant with -_ Marl@ _Ro /itshi., SIM Hallt 00 Rositam r. - - in the property described as follows; Commencing on the east line of the Southeast Quarter of Section 8, Town 28, Range 15, 807 feet north of the southeast corner th+ereofl thence N 89!27' west 160.E ,ta_ _. �__., __ _ Qe .._ 'y�•3tt' itfart; "x27 ".'� firett enoe N 032' sit, 20.I i�et{ tbena� N'89•25 Rest 263 feat{ thence South on east line of •aid Southeast Quarter 197.5 feet to place of beginking. Subject to Certain water rights as set out in that certain Warranty Deed dated June 13, 1963 and recorded July 9, 1963 in Velnne 395 of Reds, page %S under Instrument No. 272987, Register of Deeds office, St. Croix County, Wisconsin REGISTERS OFFICE ST. CROIX CO., WIS. Recd for Record this_ 10th_ day of 19_74 at------ - A. M. Said estate was (not) * subject to an inheritance tax (LA11eil 11mg beipoll Rex; ster of Deed• And the joint tenancy of - Walter F. Re sit s ki in the proR4riy was terminated as of the date of death, and _ - _ - _ Marie Rositski_, _N4;4 Marie 0 Bes (is) * (V'M the surviving joint tenant. y IN TESTIMONY WHEREOF, I have signed this certificate and affixed the seal of the -Court Gavie, Richardson sad Skew on Attorney - - - - -- Spring Palley, Wi. 7 � — sepk W. �g�rea County Judge Add ress Recorded in Vol. .-- * Strike as appropriate. N Rev 197gV CER LIFICATE OF TERMINATION OF JOINT TENANCY S 867 1 M. C ■ llf l CO..I \�lY[CC ST. CROIX COUNTY WISCONSIN ZONING OFFICE N N W M • — Novell ST. CROIX COUNTY GOVERNMENT CENTER \ 1101 Carmichael Road �'N•' - ..�- --� Hudson, WI 54016 -7710 (715) 386 -4680 FAX (715) 386 -4686 NOTICE OF VIOLATION October 12, 2001 MARIE ROSITZKI 418 290TH ST. WILSON, WI 54027 RE: Failing septic system at 418 290th St. Town of Cady - St. Croix County, WI Computer # 004 - 1018 -80 -000 Parcel # 08.28.15.128B Dear Mr./Mrs. Rositzki: As required by the ST. CROIX COUNTY ZONING ORDINANCE, notice is hereby given that you are in violation of § 254.59(2) Wisconsin Statutes, COMM 83.32(1) Wisconsin Administrative Code, and Article 15.04 of the St. Croix County Zoning Ordinance. This system has failed under the definition in § 145.245(4)(b) Wisconsin Statutes (Category I). This violation was first noted on 10/12/2001. The violation noted is septic effluent discharging to zones of saturation. An on -site inspection on 10/12/2001 did reveal the septic effluent discharging to zones of saturation and to ground surface. If fines and or forfeitures become necessary to bring about the abatement of this violation, they will be assessed as of 10/12/2001 in accordance with Chapter 145.12(4) Wisconsin Statutes. THE FAILING SANITARY SYSTEM ON THIS PROPERTY POSES IMMEDIATE HEALTH CONCERNS AND NEEDS PROMPT ATTENTION. REQUIRED ACTION: By December 1, 2001, contract with a certified soil tester to have a soil evaluation conducted. The soil evaluation will determine the type of septic system needed and it's location. Then contract with a licensed plumber, who will design the septic system and obtain a sanitary permit through this office. The septic system must be installed no later than June 1, 2002. If you have any questions or concerns that I can address for you in this matter, please feel free to contact me. I look forward to working together to resolve this matter. Sin rely, Kevin Grabau Zoning Technician cc: file air Q57 Safety and Buildings Division County o NPI.4c 01 W. Washington Ave., P.O. Box 71 Madison, WI 53707 - 716 Site Address Department of Commerce Sanitary Permit Application _� Sanitary P`rmit °mbe In accord with Comm 83.21, Wis. Adm. Code, personal informa6 11 you p�ovide !► may be used for second purposes Privacy Law s15.04 l) m "` /, 11 Check if Revision I. Application Information - Please Print All Information Q v . State Plan I.D. m �� ` 1. N P Lu roperty Owner's b ane ' � Parcel Number - 4 zna 1• €" Property Owner's Mailing Address 1 . ©� Property Location -1 �• �p'� �C'k G.'4;S T N R jS) City, State Zip Code �� Pho r Lot Number Block Number I �£= r �� � , . , `t �I i Subdivision Name CSM Number l,U1 540'7 ; H. Type of Building (check all that apply) ��// `/ ❑City X1 or 2 Family Dwelling - Number of Bedrooms .4 5& roo YYI ❑Village ❑ Public /Commercial - Describe Use ownship ❑ State Owned Nearest Road OL �l III. Type of Permit: (Check only one box on ine A (numbering scheme for internal use). Complete line B if applicable) A. 1 11 New 2 Replacement System 3 ❑ Replacement of 6 ❑ Addition to For County use system Tank Only Existing System B • ❑ Check. if Sanitary Permit Previously Issued fermt Number Date Issued IV. Type of Permit: (Check all that apply)(numberI scheme is for internal use) 20 4/0 11 44 Non - Pressurized In- Ground 47 El Sand Filter 50 11 Constructed Wetland 22 - Ground 41 ❑ Holding Tank 48 El Single Pass 51 ❑ Drip Line 45 A7Grade C1 46 Aerobic Treatment Unit 49 ❑ Recirculating 30 11 Other reatment Area Information: UAI « Design d) l Di spersa Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals. /Days /Sq.Ft.) (Min./Inch) 10a r Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Holding Tank �! • fi Dosing Chamber _ A J , O �Ct bG VII. Responsibility Statement- I, the undersigned, ass a resp flit r or installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Sig P /MPRS Number Business Phone Number Plumber's Address (Stteet, City, State, Zip C e) VIII. County /De artment Use Onl ' KApproved ❑ Disapproved Sanitary Permit Fee includes Groundwater Date Issued Issuing Agent Signature (No Stamps) / El Owner Fee) Owner Given Initial Adverse . 1_6 3 4 Determination IX. Conditions of Approval/Reasons for Disapproval 1. The existing system must be abandoned per code requirements. 2. Effluent filter to be installed and maintained per manufacturer's recommendations. 3. Floodplain mapping = Zone "C" ks to s stem and residential structure must meet applicable code requirements. 5. Well setbacks to be m4ffffih9@�1t1e1f"lt4 W �h�Pty only) for the system on paper not less than 81/2 x 11 Inches in size 6. Wisconsin Fun st e. S _ W s� a�A� w► �v/10 SITIr 07 13':001 FRI 09:01 FA., 1 715 232 4099 DLNN COUNTY DEVELOPMENT 4003, PART B. TO BE COMPLETED BY THE GOVERNMt±NT U NIT 1. ERIFICATION OF OWNERSHIP Does the owner(*) names) as listed on ilia docu rent used to verify ownership agree with the name(s) of the applicants) on Part A of this application? f Yes ❑ No Mal document was used � Document or W verify ownershiA? Page Number If the applicant answered yes to question 3 on Part A of this application, did the applicant own the property whorl the orderlvertlication of failure was issued or the R§tem installed acrd incur the cost of replacernent? C Yes ❑ No 2. Is this application for a replaosrnerrt structure? O 0 No if yes, have all r Werrwnts outlined In Comm 13720(4), Y&. Adm. Code, been met? ❑ Yes 0 No 3. Is a pW ic sewer aval(oble to this 0 Yes No 4. Etas a previous grant been warded for this property under this ram? D Yes No S, Principal Residence evidence of income. Please indicate applicable annual Income: $ 6. if 3 a Federal Inc=a tax fora► Line . Year / Affidava of , Year Other form used stir � J 1 , Line . Yvar -.- - -- Small Cormneroial Esfabkshrnant evidence of income. Please Indicate applicable annual gross income; Profit E loss form used: . pine ,'rear a. Date of Order or ` ) Age of trig Determination of Failure: f� 1 existing failed system;- Se Distance from the botbm o the eidsti failed system to a limiting factor, 7, Private sewage system fallm caused by dlscharpe of sewage to (check all that appbr): Guffawwater or groundwater ............. .. ............ ............ .. ............................... category A zone of s WrAfion .. ...................... ............ .. ......... ...... .... ........... .......................... ... ... ...... --.- 0 A drain to or zone of bedrodt ......................................................................»..,.... ...........- ,...,.............. ❑ CatWry The stuisce of the ground ............... .... ..................................... ... . ..... .................... .....:... ...,� Category 3 B'acK'up of aw age Into the sh uchae served. ........................ »............................ ............................... IV 8. • Replacement System Type: 0 L`onverlti" 0 In-ground Prossure 7 At -grade %Mound 0 Holding Tank 0 Experimental System 0 Monitoring � 0 Mer, explain Uniform Sanitary Permit Number /'� _ Oats Issued. Plan Approval Number Date APMVed Experiment Approval Number • DAD Approved 9. Mbe O or ! ft 0 Reaeon ble: • I 10. Governmerrial brill Representariva's Ce►tificaWn. t certify that I have reviewed and verified all information provided on this form NO atlachfmwas and that ow are true and correct to the best of m e and belief. ftnatwe of Authorized Governmental Unit Representative True hate Signed RECER AUG 2, 0 SAFETY & BL f�. ST. CROIX COUNTY WISCONSIN rrrxrrr�� " ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 (715) 386 -4680 • Fax (715) 386 -4686 December 10, 2001 OIL- Vh Marie O. Rositzki 418 290 Street Wilson, WI 54027 Dear Ms. Rositzki: Your application for Wisconsin Fund Sanitary System Replacement reimbursement was received by this office. I have checked items on the list below that are still needed from you in order to process your application. z..9 $100 filing fee ❑ Copy of warranty deed showing ownership of property isconsin income tax form (total taxable household income must be less thmf$45,000 for the fiscal year in which you apply) y Cancelled check or copy of any paid receipts showing the amount you paid for the cost of the replacement system Please submit the necessary information before December 26, 2001, to St. Croix County Zoning Office 1101 Carmichael Road Hudson, Wisconsin 54016 Enclosed is a copy of the Wisconsin Fund brochure for your information. Should you have further questions, please call me at (715) 386 -4680. Sincerely, Judy Olson Zoning Secretary Encl. ST. CROIX COUNTY WISCONSIN ZONING OFFICE a ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 (715) 386 -4680 • Fax (715) 386 -4686 December 31, 2001 Ms. Marie Rositzki 418 290' Street Wilson, WI 54027 Dear Ms. Rositzki: I find that we need to include an Affidavit for Low Income form with your Wisconsin Fund Application. Will you please complete the enclosed form and sign it with a Notary Public, then return it to me in the enclosed envelope. We need this within the next 10 days. Thank you. Judy Olson Zoning Secretary Encl. If the owner feels they are eligible and would like to apply, they should now complete Part A of the Wisconsin Fund application. The applicant will be instructed to supply the county with a copy of their federal income tax form if applying for a principal residence or their federal profit and loss form if applying as a small commercial establishment. Income is verified with tax forms for the year of or the year prior to the order or determination of failure. 4. A certified inspector for the state or county, with a physical inspection, verifies the failure. An enforcement order or determination of failure is then issued to the owner. 5. Once the enforcement order or determination of failure has been issued, the system can _ be replaced. An owner is not eligible if the physical replacement of the system began prior to the issuance of an enforcement order or determination of failure. 6. The county representative then processes the application, which includes completing Part B of the Owner's Application and the Grant Worksheet. A ompleted applicant's file will contain: � .2 S.IS Owners application, l ,n J z s Grant worksheet, y (� Sanitary permit application, �D Copy of the approved plans, Verification of ownership, �} Income tax form verifying income, Total cost of system replacement, Onsite report verifying that the system has been installed and is working in compliance with the state plumbing code, If there were unusual circumstances surrounding the application, additional documentation would be required. For example, a real estate sale would require a copy of the deed verifying dates of ownership and a copy of the sale contract, paid receipts or canceled checks showing the applicant incurred the cost of replacement. Another example is a trust or estate. Keep a copy of the agreement on file. 7. To be eligible for an award in the next fiscal year, applications sent to Commerce must be postmarked by January 31. Information submitted to Commerce for each eligible applicant would include: Copy of the owner's application, f Copy of the grant worksheet, Copy of the sanitary permit application, Copy of the approved plot plan, Copy of the final inspection report, if available, and .Additional information when it is necessary to determine eligibility. ST. CROIX COUNTY WISCONSIN ZONING OFFICE �\ / N / / W N ■ r���r ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 .>- (715) 386 -4680 FAX (715) 386 -4686 NOTICE OF VIOLATION October 12, 2001 MARIE ROSITZKI 418 290TH ST. WILSON, WI 54027 RE: Failing septic system at 418 290th St. Town of Cady - St. Croix County, WI Computer # 004 - 1018 -80 -000 Parcel # 08.28.15.128B Dear Mr./Mrs. Rositzki: As required by the ST. CROIX COUNTY ZONING ORDINANCE, notice is hereby given that you are in violation of § 254.59(2) Wisconsin Statutes, COMM 83.32(1) Wisconsin Administrative Code, and Article 15.04 of the St. Croix County Zoning Ordinance. This system has failed under the definition in § 145.245(4)(b) Wisconsin Statutes (Category I). This violation was first noted on 10/12/2001. The violation noted is septic effluent discharging to zones of saturation. An on -site inspection on 10/12/2001 did reveal the septic effluent discharging to zones of saturation and to ground surface. If fines and or forfeitures become necessary to bring about the abatement of this violation, they will be assessed as of 10/12/2001 in accordance with Chapter 145.12(4) Wisconsin Statutes. THE FAILING SANITARY SYSTEM ON THIS PROPERTY POSES IMMEDIATE HEALTH CONCERNS AND NEEDS PROMPT ATTENTION. REQUIRED ACTION: By December 1, 2001, contract with a certified soil tester to have a soil evaluation conducted. The soil evaluation will determine the type of septic system needed and it's location. Then contract with a licensed plumber, who will design the septic system and obtain a sanitary permit through this office. The septic system must be installed no later than June 1, 2002. If you have any questions or concerns that I can address for you in this matter, please feel free to contact me. I look forward to working together to resolve this matter. Si Kevin Grabau Zoning Technician cc: file 07,'13/2001 FRI 08:01 FAX 1 715 232 449 DUN:r C:LONTY Vhh ELUYJLEI'1l 1 � x� LODU4 State of Wisconsin WISCONSIN FUND - PRf\/ATF SEWAGE SYSTEM + t rs artmen! of Sa f* and P REPLACEMENT OR REHABILITATION PROGRAM �� �� Buildings Commerce � � Division OWNER'S APPLICATION Instructions For Pro Uttrners: 7O:f3 OMPLETED BY C0MMEl2GE Yaal may apply for tl QrSnt.1ilWa for up to three years after You have received oliu;rrNurn6er a deteminetion of failure and after you have obtained a sankay permit. Complete Pali A of this form, *ftM a:vidaanc a of your annual income explain in Section #7, and Send those items to the governmental unit listed below. :. :. An application fee o f $200.00 will be charge for all successful rant applications. { PART TO 8E COMPLETED BY THE PROPERTY OWNER Owner Name' _ 5oo W 5ectutty No. Additional Owner �So�ia1$ectwity No'" teS6 Atlath d6 of adcliflonal owners if needed. City. 3516 zip coft Wephor._ Mumt:er; rwtude ores code - ft� S � * ''Note: Your Social Security iy Number ay be used b rdify ytrr 'Grant awards wig be issued in ti►e name and address of taus owner, income and e(atus of gild support or malntanarM wymentq ' i. Was the fstatrp prtvale 96WA a system Savieg the pdndpal residence or small conrmerdai establishment constructed pro_ r to,duty 1,19787 Yes 0 No 2. TNs appncatim W for bolo if applicable); ,9 MMaptaa Residence Do you oowPy this residence at least 51 °/. of the year 19Yes [IN. ❑ Smali Conxrfpro al Eatablishrwt Do you o=Mv this mmil mmmorcW estaMWm*n( al least S1 % of the roar. ❑ Yes ❑ Ido Smaii Commercial Esbblistvnent Nwm: Description 0r$M 1 C*avrg cW EsbblLshrrwnt lean, re stau!2m, plc. , 3. Was the P"fp rpwago WA*m ""d caw Pbrt af a real e51bte trwsaction or amme o!ownemwp? ❑ Yes VI No If 4. As the ONW, are you a 11o9raed Diumbar or Wntractor engaged i the business of t rujing privale sewage sys*ms7 ❑Yes w 5. Will a portion d this system be RarXW by sr>atrer source? ❑ Yes No If M. ex4lah e. How did you hear about the WisCOrtsin Fu ate sawa System Replooerrient or Rehabilitation Pmgrarn7 7. Ev sx� of Yleofrte. Atladi copy of yoursederal lnoomt: tax r for the hear of of prior to the enforcernetlt order or determinsilon of fakure if you are apptyinp as a principal residence. If you are applying as 0 small oomrnemial establishment, submit Q OW of your fedt3 W profit and IM forms for the year of or prior to rite order or deteru kutian of falk". if you were nuirded and Tiled sepastalatr fofM, you must also ilcbude your .spouse's return 1br the same year. You must Include evldenoe of income for each owner (and nor each tawrwr's as MUN) fisted above, Evidence of Income will be kept on file at ttie governmental unit end is 9ubjedio veffi gation by U* Department of Revenue and by the Departrnertt of Commerce, if you or arty owrlef above were a RW12E aaaasklent or did riot Ilia an incottl9 tax return cordact yo govarrirmntal unit for further Instruclion5. fi. Property Owners Cet115CRIi0n. 1 Ceittiy that, to the best of my knowledge and belief, the inforinatipn I have provided on this form and al atfadfinenb we hue and ctorrect owners 3900 Da signature Claoe Signed Personal Womiatim you provide may be used for spoondary proposes nvacy Law, s. 15.Q4(1 Xrn)j. SBb.9163 T - 112°K*' RECEIVED lsa ii- 9.1 o X001 SAFETY & BLOGS Din 1 1 PART B. TO BE COMPLETED BY THE GOVERNMENTAL UNIT INERIFICATION OF OWNERSHIP Does the owner(s) name(s) as listed on the document used to verify ownership agree with the name(s) of the applicant(s) on Part A of this application? X Yes ❑ No What document was used Document or to verify ownership? tJ&A"t Page Number If the applicant answered yes to question 3 on Part A of this application, did the applicant own the property when the ordedverification of failure was issued or the system installed and incur the cost of replacement? 0 Yes ❑ No 2. Is this application for a replacement structure? 0 Yes A No If yes, have all requirements outlined in Comm 87.20 4 , Wis. Adm. Code, been met? 0 Yes - No 3. Is a public sewer available to this property? ❑ Yes No 4. Hasa previous grant been awarded for this roperty under this program? 0 Yes No 5. Principal Residence evidence of income. Please indicate applicable annual income: $ tc36 D-Y1 Federal income tax form , Line , Year Affidavit of Year dD0 Other form used Line , Year Small Commercial Establishment evidence of income. Please indicate applicable annual gross income: $ Profit & loss form used: , Line , Year 6. Date of Order or r p _ _ Age of the p _ � _ / _. �,_ Determination of Failure: ©" �� 2 existing failed system: �`' 1' SeRarating Distance from the bottom of the existing failed system to a limiting factor: 7. Private sewage system failure caused by discharge of sewage to (check all that apply): Surface water or roundwater.. ❑ ory A Zone of ra o ............................................................................................. ............................... Adrain file ne of bedrock ............................................................................... ............................... ❑ Category 2 The surface of the ground ...................................................................................... ............................... ❑ Category 3 Back -up of sewage into the structure served ........................................................ ............................... ❑ 8. Replacement System Type: 0 Conventional ❑ In -ground Pressure XAt -grade ❑ Mound ❑ Holding Tank 0 Experimental System 0 Monitoring C1 Other, explain Uniform Sanitary Permit Number 3 Date Issued �°l/l Plan Approval Number � 1? o Date Approved 2 1 Experiment Approval Number Date Approved �- 9. Eligible 0 or Ineligible 0 Reason Ineligible: 10. Governmental Unit Representative's Certification. I certify that I have reviewed and verified all information provided on this form and attachm and that they are true and correct to t he best of knowledge and belief. Signature of Authorized Governmental Unit Representative Title Date Signed lJu� & State of Wisconsin . PRIVATE SEWAGE SYSTEM REPLACEMENT Safety and Department of OR REHABILITATION GRANT PROGRAM Buildings Commerce Division GRANT WORKSHEET Owner's Name: Governmental Unit: G I:'IiINDING TABLES A. Site evaluation and soil testing. Grant amount $250. $ S. Installation of a replacement or additional septic tank. Minimum Gallons Required Grant Amount 750 .......................................................... ............................... ...........................$500 9J5 .......................................................... ............................... ............................550 t&, 200 .......................................................... ............................... ............................650 1 , 425 ...................................................................................... ............................... 725 1, 650 .......................................................... ............................... ............................750 1, 875 .......................................................... ............................... ............................875 2,100 or more ............................................. .................I.............. ............................950 $ C. Installation of a pump chamber and lift pump or siphon: Numberof Bedrooms ..................................... ............................... ................................. Grant Amount 1 or2 $1,100 } 3 1,200 5 or more .........................1,250 $ D. Installation of a non - pressurized or in -ground pressure soil absorption area. 1. The following table shall be used for systems sized acooFding to percolation tests. Grant amounts determined by number of bedrooms. Percolation Rate Design Loading When Property Rate in Gallons Filed with County Per Square 1 2 3 4 5 Each Addl Before 7-2-94 Foot Per Day Bedroom: Minutes Per Inch 0 to less than 10 0.7 or more $ 800 $1,100 .$1,225 $1,400 $1,725 $150 10 to less than 30 0.60 to 0.69 900 1,175 1,400 1,800 1,900 250 n 30 to less than 45 0.50 to 0.59 1,050 1,450 1,650 1,950 1,975 300 45 to less than 60 0.49 or less 1,150 1,900 2,200 2,250 2,275 300 E. Installation of an at -grade or mound soil absorption area. Grant amounts determined by number of bedrooms. Type of Design 1 2 3 5 Each Addl Bedroom: At -Grade $900 $1,300 $1,475 $1,825 $1,950 $250 h Groundwater Mound 2,250 2,325 2,550 3,400 3,775 250 High Bedrock Mound 2,350 2,950 3,000 3,400 3,525 275 Slowly Permeable Mound 2,900 3,100 3,250 3,400 3,650 300 Mound with less than 24" of suitable soil or greater than 3 �p 12% slope. 3,050 3,400 3,475 3,550 4,500 375 $ F. Installation of a holding tank. Addl Number of Bedrooms: 1, 2 or 3 4 5 6 7 8 Bedrooms Grant Amount: $2250 2,925 3,100 4,000 4,200 4,750 $225 $ X G. Installation of a Replacement Exterior Grease Interceptor by Gallon Capacity. Gallons: Up to 1,249 1250 -1,499 1,500 -1,749 1,750 -1,999 2,000 or more Grant Amount: $550 $650 $750 $800 $900 $ Personal Information you provide may be used for secondary purposes (Privacy Law. s. 15,040 xm)]. SBD -9167 (R. 1199) PART: GRANTiFUNDING{TABLES continued 1 H. Installation of an Experimental System. Amount Requested For Installation: The Department on a case -by -case basis reviews installations of experimental systems. If you ` are requesting funding for an experimental system not covered by the grant funding tables, $ x please submit a copy of the plan approval letter and experiment approval letter with corresponding Identification numbers signifying that the experiment has been accepted by the Amount Requested Department of Commerce. For Monitoring: List the total cost of the experimental system and monitoring that is being requested separately X at the right Copies of paid invoices must be submitted with this request $ L Installations not Covered by the Grant Funding Tables. The Department on a case -by -case basis reviews installations not covered by the Grant Funding Tables. If you are requesting funding for an installation not covered by the grant funding tables or listed in Sections A H, please explain your request here, attach a copy. of the paid invoice, and request 60% of the cost of the installation at the right. $ X TOTAL PART 1. D L) `.P.AR aiRANT #M!DUN iALCULATIQNS. A. Enter the total from Part 1. $ B. Is the applicant a licensed plumber or contractor who installs private sewage systems? If yes, enter 213 of the amount from section A or $4,667, whichever amount is less. C. Enter the smaller amount listed in sections A or B. If this application is for a small commercial establishment and the annual gross income of the business that owns the small commercial establishment is less than $362,500, this is the total grant award. Carry this amount forward to section F. If this application is for a principal residence and the annual family income of the owner(s) is less than $32,001, this is the total grant award. Carry this amount forward to section F. If this application Is for a principal residence and the annual family income of the owner(s) is greater than $32,000, goes to section D. If this application is for an experimental system, carry this amount forward to section F. $ - 5- C O. D. Enter 30% of the amount by which the applicant's annual family income exceeds $32,000. Annual Family Income Subtract - $32,000 Subtotal X .30 = $ E. Subtract line D from line C. This Is the maximum grant amount for this applicant. Carry this amount forward to section F. (The amount in section E must be at least $100 to be eligible for any grant award. If the amount calculated is less than $100, y enter $0.00 in section F. ) $ F. Total grant award requested for this applicant $ - 5 - 5e o ' eg v Safety and Buildings Division Couny o \ V l' s 201 W. Washington Ave., P.O. Box 7162 , eonsi►n Madison, WI 53707 - 7162 Site Address De �rtmant of Commerce kk 2 Sanitary Permit Application Sanitary Permit ti°mber In accord with Comm 83.21, Wis. Adm. Code, personal informa64 you pkv i ❑Check if Revision may be used for secondary purposes Privacy Law I. Application Information - Please Print All Information v� State Plan I.D. m L Property Owner's Name , Parcel Number r r - 4 - I Property Owner's Mailing Address i Q Property Location CN -1 Q . 'k J�JE'�;S 8 T N.R �J City, State Zip Code PhonVOMWer Lot Number Block Number Subdivision Name CSM Number II. Type of Building (check all that apply) ❑City XI or 2 Family Dwelling - Number of Bedrooms - 4 1 corn ❑Village ❑ Public /Commercial - Describe Use ownship ❑ State Owned Nearest Road M. Type of Permit: (Check only one box online A (numbering scheme for internal use). Complete line B if applicable) A. 1 ❑New 2 Replacement System 3 ❑Replacement of 6 ❑ Addition to For County use System Tank Only Existing System B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbe scheme is for internal use) ZO eq S�. , f �� O 44 11 Non - Pressurized In- Ground 47 ❑ Sand Filter 50 ❑ Constructed Wetland - Ground 41 ❑ Holding Tank 48 11 Single Pass 51 ❑ Drip Line .4p 45 At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other reatment Area Information: U,n.7 • Jr /, (� Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals. /Days /Sq.Ft.) (Min./Inch) Elevation �pCV o ov /03. Z VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Holding Tank Il e Dosing Chamber A - O a 766G ` VII. Responsibility Statement I , the undersigned, ass4me reap flit for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Sig P /MPRS Number Business Phone Number Plumber's Address (Stteet, City, State, Zip C e) _3 311W VIII. County /De artment Use Onl Sanitary Permit Fee 'includes Grotmdwater Date Issued Issuing Agent Si s �pproved ❑Disapproved gn�ure (No Stamps) ) Surcharge Fee) ❑ Owner Given Initial Adverse 3")-s" �/ �, Determination I IX. Conditions of Approval/Reasons for Disapproval 1. The existing system must be abandoned per code requirements. 2. Effluent filter to be installed and maintained per manufacturer's recommendations. 3. Floodplain mapping = Zone "C" w 4- All setbac to system and residential structure must meet applicable code requirements. 5. Well setbacks to be m 4ffft%b d M I%jW (tt VW gUpty only) for the system on paper not less than 81/2 x 11 Inches In size 6. Wisconsin Fun st e. S - (WNS� a�A1 w► . FV �► �0 %1T1r ORIGINAL 1354 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety nd Buildings Y in accordance with Comm 85, Wis. Adm. Code Certified Soil Testing oun Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 004- 1018 -80 -000 Please print all information. Rep* Y Date Personal information you provide may be used for seco purposes (Privacy Law, s. 15.04 (1) (m)). , �® P rope rt y Owner Property L ki Rositzki, Marie Govt Lot SE 1/4 SE 1/4 S 8 28 N R 15 W roperty wne s ailing ress Lot # Block # Subd. Name or CSM 418 290th St. City State Zip Code Phone Number Cit ® Village a Town Nearest Road Wilson WI 54027 715 - 772 -3185 Cady 290Th St. ., New Construction Use: 0 Residential / Number of bedrooms 4 Code derived design flow rate Replacement Public or commercial - Describe: . `',/ V . Parent material till Flood plain elevation, if ap ktable ^r ~ NA - General comments t ^�9 and recommendations: install 10'x 120' effective (12'x 120' overall) rock unit at -grade system w/ laterals �ollowing , 41.6 contour t ❑ Boring # 2 Boring a Pit Ground Surface elev. 98.8 ft. Depth to limiting factor 22 in. toil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0 -3 10YR 3/2 - sl 2 m gr ds cs 1f /m .5 .9 2 i 3 -10 10YR 3/2 - sl 2 f sbk ds cs if .5 .9 3 10 -22 10YR 4/4 - sl 2 m sbk dsh cs if .5 .9 4 22 -34 10YR 4/4 c2p 7.5YR 4/6,5/3 sl 2 m sbk mfr Cs - .5 .9 5 j 34 -39 7.5YR 4/4 - s 0 sg ml cs - .7 1.2 6 39 -45 7.5YR 4/4 c2p 7.5YR 5/8,5/3 sl 0 m mfr - - 3 .4 i i Boring # J I Boring a Pit Ground Surface elev. 101.6 ft. Depth to limiting factor 38 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. 1 0 -3 10YR 314 - sl 2 m gr ds cs 2f1 m .5 .9 2 3 -8 10YR 3/4 - sl 2 f sbk ds cs if .5 .9 3 8 -15 7.5YR 4/4 - sl 2 m sbk dsh Cs if .5 .9 4 15 -30 7.5YR 4/4 - sl 3 m sbk mfr cs if .5 .9 5 130 -38 7.5YR 4/4 - s 0 sg ml as - .7 1.2 6 i 38 -48 7.5YR 4/4 c2p 7.5YR 5/8,5/3 sl 0 m mfr - - .3 .4 I Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOO < 30 mg /L and TSS < 30 mg /L CST Name ease rint ig ure: Number Henry F. Grote 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 7/20/2001 715- 233 -0398 t Property Owner Rositzki, Marie Parcel ID # 004- 1018 -80 -000 Page 2 of 3 Boring # Boring Pit Ground Surface elev. 101.0 ft, Depth to limiting factor 59 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDN in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-4 10YR 3/2 - sl 2 m gr ds gs 1f /m .5 .9 2 4 -11 10YR 3/2 - sl 2 f sbk ds cs 1M .5 .9 3 11 -22 7.5YR 4/4 - SI 2 m sbk dsh Cs if .5 .9 4 22 -28 7.5YR 3/4 - Is 0- Sg dl Cs - . 7 i 1.2 5 28 -46 7.5YR 4/4 - s 0 sg ml cS - 7 1.2 6 46 -59 7.5YR 4/4 - Is 1 m sbk mvfr cs - . 7 1.2 7 59 -62 7.5YR 4/4 c2p 7.5YR 5/8,5/3 sl 0 m mfr - - .3 .4 F4-1 Boring # IN Boring Pit Ground Surface elev. 101.6 ft. Depth to limiting factor 38 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0 -3 10YR 3/2 - SI 2 f sbk ds Cs 1f /m .5 .9 2 3 -8 10YR 3/2 - SI 2 f -m sbk ds CS if .5 .9 3 8 -15 7.5YR 4/4 - sl 2 m sbk dsh Cs if .5 .9 4 ! 15 -38 7.5YR 4/4 - s 0 Sg ml cs - .7 1.2 5 38 -44 7.5YR 4/4 c2p 7.5YR 5/8,5/3 SI 0 m mfr - - .3 .4 horizon 4 has occasions inc usions is + stratified 7. Is an s: 4 ippmg a out egrees to south a Boring # Boring Pit Ground Surface elev. ^95.7 ft. Depth to limiting factor 15 in. Soil Application Rate Horizon I Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0 -5 10YR 3/2 - sl 2 m gr ds Cs 1f /m .5 .9 2 5 -15 10YR 5/4 - sl 2 m sbk dh Cs 1m .5 .9 3 15 -30 7.5YR 4/4 c2d 7.5YR 4/6 sl 2 m sbk mfr CS if .5 .9 l OYR 6/2 4 30 -34 5YR 4/4 f2d 7.5YR 5/3 SI 0 m mfr - - .3 .4 - -1- existing "system is ategory i failure by WI Fund standards Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L " 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. S1313-8330 (R 07/00) CefbW Soil Testing t tan' S GN � � ll +YC.Q vn. w p :M (..44.o -xv .. aY� r. W r v+► 1 `v r-Mr QA. ch- V t L 4 ` S a.v SoA ' S Q/y y= a � J ti, t 0.� � •� . �o is o 4r ., � Q % 4 �� rral� �L1r,1 �1 Qa.� Yp `� a . l O 1. 1a ��► +'o `1, V` l 3 a� g No. S-1. Warranty Deed— Common Form ,y .;� (STAtz OF WISCONSIN) 2 Published by Eaa Clalre Book t Ststtenry Co. See. 836.16. Wis. Statutes. Form No. I 25 (94t0i Jubjenturr Made this 3 1 s � day of August , A. D., 19 57 , between • Walter F. Rositzke, and Marie Rositzke, his wife part y of the first part, and • Walter F. Rositzke and Marie Rositzke, husband and wife and as joint tenants. • part ies of the second part. =ftnt00et §: That the said part y of the first part, for and in consideration of the sum of 'One dollar ($I.00) and other valuable consideration ' to him in hand paid by the said part ies of the second part, .the receipt whereof is hereby confessed and acknowledged, ha s given, granted, bargained, sold, remised; released, aliened, conveyed and confirmed, and by these presents does give, grant, bargain, sell, remise, release,. alien ,-convey and--- confirm unto the said part ies of the second part, their heirs and assigns forever, the following described real estate, situated in the County of St. Croi'X and State of Wisconsin, to -wit: South One -Half (St) of the Southeast Quarter (SE- of Section 8 Town 28 North Range 15 West. The purpose of this deed is to create a joint tenancy between the parties hereto. The consideration for this conveyance is less than $500.00 and therefore no Revenue Stamps are required. A. `s ' f S 0016Y i L� 9 Sogttoet with all and singular the hereditaments and appurtenances thereunto belonging or in anywise appertaining; and all the estate, right, title, interest, claim, or demand whatsoever, of the said part y of the first part, either in law or equity, either in possession or expectancy of, in and to the above bargained premises and their hereditaments and appurtenances. _ Co Vabe anb to 1?o1b, the said premises as above described with the hereditaments and appurtenances, unto the said part ies of the second part, and to ' their heirs and assigns FOREVER. anb tbt %atb Walter F. Rositzke 9 and Marie Rositzke, his -ife 344 second part, their heirs and assigns, against all and every person or persons, lawfully claiming the whole or any part thereof, they will forever WARRANT and DEFEND. 71t UnfOO IMOM04 the said part y of the first part ha hereunto set hi hand and seal ; this 3 + r day of August , A. D., 19 57 �v ` eal ned and rS�"ed' e of Walter F. ositzke CIF • •- ��._.l..l_._.. ...._.....(Seal) _...._..•.M_ Marie Rositzke Robert R. Gavic _.._. _..........._. _ ..........._...__(Seal) Barbara Rudesill _ ---- --• - ----r _..(Seal) $tatt Ot ilMi0con0in, Pierce # ss, wM..._........._.._ _. _ _ �__. _ .... County. Personally came before me, this IdT day of August, A. D., 19 57 , the above named Walter F. Rositzki tome known to be the person who executed the forego' g i trument a ac edged t4, same. This Instrument Prepared by Robert R Gavic Robert R. Gavic, Attorney at Law `� �, r Spring Valle l��isconsin P 9 Y Notary Public, P c Goff nty, mmn. My commission expires.:.._.._ 1Q -A�,�`� " (N. �.' r 111i" �glT s. Witnesses WV a and . State. prmlda the! all iinstruments instruments to I reeoraea rhail have ptalnb printed or tfpe�rr a itten thereon the ,naasr or VIP grantees. wlta ...QLe.'7•).. _ . p ... wt 40 v O Cq A w N N R, LO 1i .40 O . Ad Ca N N A Q. (n a 4J a Ad 'V'' w o .� a H rx •� O v � A. a ti k o 2 a 4) W o ° a I i lu •� y O m y • :era t. :.ti�ik.ili i v 'A[ STATE OF WISCONSIN $t• Croix _ - COUNTY COURT PROBATk JBMICH j - - - -- - -- .. • • IN THE MATTER OF THE JOINT TENANCY j IN ESTATE OF ( CERTIFICATE OF TERMINA. � OF JOINT TENANCY v W alter F• 8osit n j 5 r of 1 A; n r h: rrl ,t i �n f la -- ec eased. - D nd ha Deceased. f ' i uiX -- - - — - - ! y c k dnCu n s•�tll,', cf cf r, i ❑)y of A -- 19 - 4 1 Marie Bositaki s�a Mary 0 • Rsaitaki r The petition of for a certificate of the termination of the joint tenancy of Waltar F. Ros1tak1 in the property hereinafter described, coming on for hearing; And it appearing that due notice thereof has been given to or duly waived by the Wisconsin Department of Revenue and the public administrator in accordance with law; And it satisfactorily appearing by the verified petition of said petitioner, who is legally interested in said matter, and by the proof submitted, that such certificate may be issj�ued; Therefore, I, JOSeph_W• Btlghes County Judge of _ St, Croix ___County, Wisconsin, do certify that _ Walter F. Ro sittekl - - - -- - -- died domiciled in n on St• Croil_ - -_ _ County, Wisconsin, on - - Novenbor I 1969 - -- - -- -_ - - -; Decedent at the time of death had an interest as joint tenant with Mario Rom itrkd ka_garie O RositsM r in the property described as follows; Comooncing on the east line of the Southeast Quarter of Section 8 Town 28, Range 15, 807 feet north of the southeast corner thersoif thence N 89.27' West 140.E to*- -- -__. theaoe - 51 .30 * west; '127: "iiretj tbienee N`n Uitt 120.1 feet{ thine N "89.25' Vast 263 feett thence South en east line of said Southeut Quarter 197.5 lest to place of beginning. Subject to certain water rights as set out in that certain Warranty Deed dated June 13, 1963 and recorded July 9, 1963 in Volume 395 of Deeds, page 568 under Instrus►ent No. 272987, Register of heeds office, St. Croix County, Wisconsin REGISTERS OFFICE ST. CROIX CO., WIZ. Recd for Record this -1 day Of__6PF_ 1----- A.D.19 -74 at----- - -8:30 A. M. Said estate was (not) * subject to an inheritance tax ( Reg star of Daad!t And the oint tenant of Walter F Resitaki l Y Walter - - - - - -_ - -- - - - - -- in the jptoRt�rty terminated as of the date of death, and Marie Rositski *Na Marie 0. Resitaki (is) * (T" the surviving joint tenant. 1 IN TESTIMONY WHEREOF, I have signed this certificate and affixed the seal of the -Court Garie, Richardson and Skew on Attorney Spring Valley, Wi. c - _ Address � . >ag�es County Judge Recorded in Vol. -- _ - -- - -_ page i. * Strike as appropriate. i N 2- Rev 197 ) C:FKUFICA "1E OF TERMINATION OF JOINT TENANCY 6.867.04 w. c. uuu co. ru•..nt ji AFFIDAVIT FOR LOW INCOME RESIDENTS COMM 87.50(3), Wisconsin Administrative Code State of Wisconsin ) County of S7` G°ra , X ass (I was, We were) (a) full year resident(s) of Wisconsin during the above - referenced tax year. (I was, We were) not required to file a federal income tax return for the tax year aeky (year) because: (Explain reason here.) Y, Signature of Owner Subscribed and sworn to before me this day of Notary Public, State of Wisconsin My Commission Expires 1 0, , r -g'y Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04(1)(m)]. LAN 6, C Coun St. Croix i is� d o D epartrnent of commerce PRIVATE SEWAGE SYSTEM Safet dnd Buml Division INSPECTION REPORT Sanitary Permit No: 399472 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Tai Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1xm))• ! 7 t City village Township Parcel Tax No: Permit Holder's Name: - 004 1018 -80 -0C Rositzki, Marie Cadv Towns h CST BM Elev. Insp. BM Elev BM Description: Wr uo� Op .p� ��sa�t�w e- �,..G�•v�� TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 26Z Benchmark 7 .. A �I Dosing Alt. BM Bldg. Sewer U � '74 • 83 t Aeration Holding St/Ht Inlet St/Ht Outlet TANK SET CK INFORMATION TANK TO P/L WELL BLDG. vent to Air Intake ROAD Dt Inlet Septic ~ 3T' I '-I Dt Bottom 13- 11. � Header/Man. 2, L( 1 Dosing N a .� 21 r e2,30 Aeration Dist. Pipe Z • 2Z 7-7-1 Holding Bot. System Final Grade C PUMP /SIPHON INFORMATION Manufacturer � Demand St Cover GPM r'O Model Number � f5w TDH Lift Friction Loss System Head 2 I T DH Ft Forcemain Lenj M 60 I ____j t Dia.2 It Dist. to Well ; }r SOIL ABSORPTION SYSTEM idth Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS d f 12 , ' ) I _MMa� SETBACK SYSTEM TO P/L BL 15G WELL LAKE/STREAM CH AMBER OR ufac INFORMATION Type Of System: �� i �� 1 -v n O r , UNIT oriel Numbe . DISTRIBUTION SYSTEM uW1. Ne• t' 1 - ") _ x Hole Size i1 x Hole Spacing 11 Vent to Air Intake Header/M ifold r Distribution I w �f Pipe 1 3 � jb ;( `t Length Dia �•. Length 9 .Dia 2 Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xe xx Mulched Depth Over Center Bedrrench Edges Topsoil ® Yes ® No ® Yes C Ni COMMENTS: (Include code discrepencies, persons present, etc.) In ecti n #1: 10 y /- 1-9� -/ 01 Inspection #2: — T-/ �� rP.w tZ(,Fcw.x f r I Location: 418 290th Street Wilson, WI 54027 (SE 1/4 SE 114 8 T28N R C�� 1 08.28.15.1288 5W) NA Lot = ��f �• tot.� S 1.j Alt 8M Description = N1A f 2.) Bldg sewer length = - z 30 G I N - amount of cover = 2 4 - .' Plan revision Required? ® N bZ dZ Use other side for additional i orm;�N Date Insepdors Signature Cart. No. SBD -8710 (R.3/97)