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HomeMy WebLinkAbout006-1035-20-100 St. Croix County Zoning Monday, July 19, 2004 at 4:20:21 PM Detail Sanitary Information Page I of I Computer #: 006-1035-20-A Sub/Plat: NA Section: 16 Parcel #: 16.31.16.240A 0 Lot: 1 TN/RNG: T31 N R1 6W Municipality: Cylon Township CSM: 1141/4: SW 1/4 SW 1/4 . . . .......... . Owner: Johnson, Jeffrey 2204 210th Avenue Deer Park, WI 54007 State Permit: 420559 Issued: 11/18/2002 POWTS Dispersal: Mound Permit: Replacement County Permit: 0 Installed: 12/03/2002 POWTS Detail: Mound Bedrooms: 3 WI Fund: POWTS Pretreatment: Unknown Notes Inspecto As Built Plumber Other Requirements Additional Notes Money Owed Pam Quinn NA Powers, Calvin Changed to Lot 1 of a 2004 CSM to split house on $0.00 Signed Off: Yes 2.96 Acres off from original 40, leaving remainder for new house at 2111 220th Street, permit #453195 Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 12/3/2005 - -- — — — — — — — — — — — — — — — — — — -- — — -- — — — — — — — — — — — — — — — — — - - - - — — — — — — — LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF CYLON COMPUTER NUMBER 006 - 1035 -20 -000 Parcel Number 16.31.16.240 OWNER NAME: First JEFFREY L & TINA L Last JOHNSON PROPERT ESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment 2204 210TH AVE SECTION WN 31N 160 '/.40 Li Description Li Description OTAL ACREAGE 40.000 PLAT LOT BLK 01 SEC 16 T31 N R16W SW SW 15 03 17 / 1 05 19 ZZU 007 2° C� 2. 08 22 — 09 23 10 24 11 25 12 26 13 27 14 28 F1- General, F4 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, F8- History, F10 -Exit N CERTIFIED SURVEY MAP OWNER JEFFREY AND TINA JOHNSOI W1 /4 CORNER LOCATED IN PART OF THE SW1A OF THE SW1 /4, SECTION 16, T31 N 2204210TH AVENUE 4 SECTION 16 RI 6W, TOWN OF CYLON, ST. CROIX COUNTY, WISCONSIN DEER PARK, WI 54007 I o SURVEYOR _ EDWIN FLANUM U rn NORTHLAND SURVEYING Z, Z Z "' N l � '` MG�IpdGQ u4C D [�JD� ��''M p.O. BOX 14 cc N 9�� R/OBERTS, WI 54023 I rn d w z O Q N 2 .�� - - -- - - W - H - o - -- C-C - � w k t�4C�G3 b� 5 "` O Y V/ 1 V S89 0 29'54 "E 386.60' Q 353 U z O v0i 0 33.03' .5T c- = Z I LEGEND 6 ~ ALUMINUM COUNTY SECTION 00 33' 33 CORNER MONUMENT FOUND p� I M ❑UND SYSTEM I I I gi g , I 0 1"X 18' IRON REBAR SET WEIGHING C 1\ g I 1.13 LBS. PER LINEAR FOOT 1 I I GARAGE r LOT 1 � & M � j a 1 0 MASONRY NAIL FOUND 6.1 1 I M W M 1 d • • - - • • • • 100 ROADWAY SETBACK LINE �I I CO MI rn 0SEPTIC 2.96 ACRES INC.R/W W oQl° I Q9 I I CLEAN ❑UT : 129,051 SQ. FT. bo o Q I pi N I I N SHED 2.44 ACRES EXC. R/W N d I D0 I 0 13 l a I �I I 106,246 SO. FT. ~ a , I RECEIVE diOoi C OI z �pJS O 0 � ICi 1 O o a1� �i o 0 Ni WELL N APR 2 0 2004 w Z z I ST.CRON000NTY # I EXISTING ZONING OFFICE I w 6' DRIVE 3 FIELD � - I DRIVE ' N89°29'5 359.34' SW CORNER 210TH AVENUE SECTION 16 � - - - - - - - - - - - - - � N89 °29'54"W 2235.46' SECTION 16 co N89 0 29'54 'W 393.01' —� I CO SOUTH LINE OF THE SW I (EXISTING (FIELD � iDRIVE ( DRIVE SCALE IN FEET 1 " = 80' I I I - - - - - - - - - THIS INSTRUMENT DRAFTED BY MICHAEL ERICKSON M [I � G° LIM D JOB NO. 04-31 DATE 3 -05-04 80 0 80 OO 1�'JHIEB o v @UM[ER% SHEET 1 OF 2 SHEETS Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division 4 o INSPECTION REPORT Sanitary Permit No: 420559 0 GENERAL INFOR:IAATION (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: Johnson, Jeffrey C Ion Township 006 - 1035 -20 -000 CST BM Elev: Insp. BM Elev: IBM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 12-1-61 � od • a Septic Benchmark / 44 /b oo l w Dosing n _ ! / D b Alt. BM � ` Aeration �+� J/� p Bldg. Sewer W ` -7 15 Holding St/Ht Inlet �. TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Kje si — Septic , , -Z a 2 y Dt Bottom Dosing 7() M Header /Man. Aeration Dist. Pipe 2 'Iq Holding Bot. Sys em / oar I L - , 73 Fina rade PUM PHON INFORMATION , ��n�c�s - esf 14 3• �I Manufacturer &TD c) Demand St Cover D9 % V b GPM µ/ C4A., S f Model Number TDH Lift I rictic System Head TD Ft • " k-1 6 3.a5 21 r 3.� Iv/ 3b Forcemain Lengt D y Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIM"S No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /- / { SETBACK SYSTEM TO P/L IWELL L E /STREAM ACH Manufacturer: INFORMATION ,Ot CHyER OR Typ System: / , r 7 f / ��� Model Number: DISTRIBUTION SYSTEM 1 / �u,•y, -U s C�ered �/ '' w ca Co Header /Manifold Distribution t I x Hole Size x Hole Spacing / - 7 to Air Intake 3 M Pipe(s)� (� r (� � b Length Dia Lengt Dia pacing A SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only og Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes [] No Yes 10 No COMMENTS: (include code discrepencies persons present, etc.) Inspection #1: / Inspection #2: t ?/ 3 , o Location: 2204 210th Avenue New Richmond, WI 54017 (SW 114 SW 1 16 TT331N R16�W))N�A Lot arcel No: 16.31.16.240 1.) Alt BM Description = (� C 1�- f�T vU+L7 v r 'c �" ° "" s1 p a � 2.) Bldg sewer length = S 0 1("4 2 A (axn¢e��r�� - amount of cover =. 1 1 - e dri) J110 B• dA4 of f't'??,0 1 �- 3.) Contour = p�. (S + Plan revision Required? 1 Yes No Use other side for additional information. i �- -� epcto s ignature Cert. No. SBD -6710 (R.3/97) Date Ins MAY and a 0 8 Oivir m COMMW v o6m I 201 VW. A - 16Z 716 C t -zo �� o�� a xftAdirm ao - a�a Pftmk Apps Nurber rm • 11 chwh if Reviman � a D S SWrr ri. :D. ,8 3 � 2 _ RE Ea PGoe1 mm °W o © 00(P— 1035-c�o -O c7 I(ol 1Vl,, S . NOV 11 2002 y tor•eM. oW car. Sara ZCidING i)i =FICE z« �� SAM trirI Nuw EHL or a Pldy t1�, - Nrebar cr 6edraMe. _ 3 'ski rz � �' n.,rft Va 0 ftft o.fte ( —7 eta a.-F 100. 3 admwm hr A. t O xs,. 2 Mo. taux"Pl a ire a I[a�ej � 3 13 Ri�Mt d 4 ©A/4llIM rs �rur1P nre A. 0 ct" K smoms pftvkm* boaa Penrir NMe6rr tree IV. vv d rw=u: (Uks* aA taw air0 aclt:,r� In tirr ieeeerrrd rree) 44 0 Mm - Ptw m*Md 21 Yo 47 0 soma PiAer 32 0 Pr ,e 1.tinxmd 30 0 Couummd w� 4313 s 7 42 0 ft* Path 310 D* Ljw V Arses �s Amoeic lYMrnrMrc 49 O 30 0 o6ar AMra / r AM soi "ppiMm'el°M � �. P'lart e�,Mae �(a1r.lD4rsr�'y.R) w►ro.� Took � (CMS d7�MtY Sled pf�C .r 1ewyr� oo.wc cr.err OoB GUS [C vet. eM.urw,I L ts= >� w.rriw ■.rur �7Ta�MS.a +� �ua.l?rS av !loeeNembrr FWAM tbMr, aj,. SOW Zlp cast) b S I � VUL S a o AgPeo d 7 P Pbe ( Dna b 0 Ow Own � � r � "` o Ana& < doe Oct 28. 02 0.8:26a CALVIN POWERS 715- 246 -5135 p.3 tAZ- Lip iodlioAcz�..- Jwl �Ef [ Gym l 7 S C f l _ :ate 3� I U41 X 1 Sr. F4D J 5 Nt.O sT SE A 5A4 b0KX -?CK COKAM, 83 .3 _W( A.. GoDE. .40 -CL crekg Safety and Buildings w 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TOO #: (608) 264 -8777 ,\ Vh4constn www.commerc .wis ons Department of Commerce www.wisconsin.gov Scott McCallum, Governor Philip Edw. Albert, Secretary October 30, 2002 CUST ID No.220537 ATTN: POWTS Inspector ZONING OFFICE CALVIN W POWERS JR ST CROIX COUNTY SPIA 1969 185TH AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/30/2004 Identification Numbers Transaction ID No. 796933 SITE: Site ID No. 651990 Jeffrey Johnson Please refer to both identification numbers, 2201 210th Avenue above, in all correspondence with the agency. Town of Cylon St Croix County SWI /4, SWI /4, S16, T3 IN, R16W FOR: Description: Three Bedroom Replacement Mound System Object Type: POWT System Regulated Object ID No.: 875465 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 Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 101) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD- 10706 -P (N.01 /01). • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • Comm 83.22(7) - 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. Owner Responsibilities: • Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. E? O.1. 'r S. Conditionall APPROVED CALVIN W POWERS JR Page 2 10/30/02 Owner Responsibilities Continued: • The owner is responsible for submitting a maintenance verification report per Comm 83.55, that is acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Gerard M. Swim POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm WSMART code: 7633' jswim@commerce.state.wi.us cc: Leroy G Jansky , Wastewater Specialist, (715) 726 -2544 TITLE SHEET DATE: - i (} - , ;t7 - 0A PAGE OF__T MOUND SYSTEM FOR A 3 BEDROOM RESIDENCE This plan has been pied in amorclawe with the Mound Cow M RRECTION NEEDED SBD- 10572 -P and the PTcss lre Disbution Mabel S13113- 10573 -P. CR. ) (CR 6/99) SEE, CORRES40NDEN LOCATED IN TH 1/4 OF 3'HLS W 1I4 OF SECTION ,Tj�h, R W, TOWN OF ran _ , ST. CROIX COUNTY, WISCONSIN. INDE3C PAGE I OF 7 TITLE SHEET PAGE 2 OF 7 PLOT PLAN RECEIVED PAGE 3 O F 7 PLANVIEW CROSS SECTION PAGE 4 OF 7 DISTRIBUTION PIPE LAYOUT OCT - 4 2002 PAGE 5 OF 7 PUMP CHAMBER CROSS SECTION PAGE 6 OF 7 SYSTEM MANAGEMENT PLAN SAFETY & BLOGS DIV. PAGE 7 OF 7 Pte' CURVE -�-- PREPARED W Aii R-A if � i wI- S 7 PRE Y POWERS EXCAVATING INC. .# aaDS3 7 1969185 AVE. NEW RICHMOND, WIS. 54017 PHONE: 715- 246 -5135 FAX: 715 -246 -5135 t,.rr+n P IYlt14 1 Ut COMMERCE DIVISION OF SAFETY OD BUILDING$ SEE G RRESPO. ENCE Oct 28, 02 08:26a CRLVIN POWERS 715 -246 -5135 p.3 r,3 M, .Kll. u- -.. t _ n � .. - , LIP }. 9°Gs _ M't?Cl /` j l Z I N d �u x 15T. Pou-)r A � tJ. b4QE b tot GoeA#A 83. 93 W(5'. ASM . c.,oDE.. v -et cris. Les -�— Page3 Of Synthetic Cox :ring Aqm C33 Distribution Pipe Medium Sand Topsoil �_ G 3 a ©/ ' �• I oa3 % Slope Bed Of 2 Force Main Plowed Aggregate Layer Cross Section Of A Mound System Using E 1 ,5 ' A Bed For The Absorption Area F �d G !, Gtv A Ft. H 4:2, •, uinear i t e B ) Ft. es , i .- oadini Rate= iPD `3 YT K 0 1, 93 Ft. L Ft. J >. fi Ft . of Position Force Hain �``� -.,, H Ft. _.. _ I_ Observation Pipe B ---- K Acces A r-S Di stribu tion { Of '2r 2 l Pipe Aggregate Observation Pipe 601chor- SW Plan View Of Mound Using A Bed For The Absorption Area Distribution Pipe Layout Page 4 of Pace the holes at the bottom of the distribution pipes at equal Spacing. Remove all burrs from the pipe and holes. F.xtead the ead of each INUW up with de use of tang tum or 45' .S=W to a paim within sic iacbear of *& mat VwhL T the =6 of the tsta W with a vatvm;:thsdod cap or thresded PbjH- lot" ide = iMM Scott ; Made for the vatye* sit eaded amp or thRadad plug. Uww Fk1i WvG LaROI�I Lat�eld c �"S R7S k OOtiD jet Lim VMCM P 3 7 f t. tole Diameter /� Inch ., ��,� Ft. zateral 'lam Inch(es) x . Inches Manifold .Z Inches Force Main " Indies t of holes /pipe v Invert Elevati of. LateralS_Ll�t. SEPTIC TANK &` PUMP CN____ MaER CROSS S�l:x�v�r ni•++ - OO 4" CI` VENT 'PIPE I2 MIN. ABOVE GRADE JUNCTIONPBOXF APPROVED VER ?: FROM,DOOR, WINDOW -OR WITH CONDUIT MANHOLE CO FRESH AIR _If3TAKE W1 PADLOCK E Cl RISER WARNING LABEL dul 40 6" MIN. ----- " _ _ 4" MIN ABOVE G ADE 1 8 " i 1 tLET t WATER TIGHT SEALS T S t `� V p A SEAL APPROVED JOINTS W/ CI � PIPE B i , ALM PIPE 3' ONTO 3' ONTO -- F° t ON SOLID SOIL SOLID C ' * RISER EXIT SOIL PUMP OFF ELEV . 't3' 2 'FT . Y OAF PERMITTED ONLY D IF.TANK MANUFACTURER HAS APPROVAL 3 APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIC SEPTIC C DOSE t , TANK MANUFACTURER: � - P1tJMBER `Dt?SES P£R DAY: TANK SIZES SEPTIC IMO GAL. DOSE VOLUME INCLUDIN 1_3 _ GAL. DOSE � GAL. CAPACITIES: A = � � INCHES = 3 'D___ ` � G AL . ALARM MANUFACTURER: 54 � ---^'. MODEL NUMBER: B 2 INCH = GAL. SWITCH TYPE: ��� - C 7� INCHES = I� GAL. PUMP MANUFACTURER: MODEL NUMBER INCHES = / AL . SWITCH TYPE: D i /� G REQUIRED DISCHARGE RATE: 3 GPM PUMP & ALARM WIRING AS PER ILHR 16.23 WA( FEET VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE - • — FEET • MINIMUM NETWORK SUPPLY PRESSURE 't' FEET • ;- _ /FEET FORCEMAIN X I � FT/100 FT. FRICTION FACTOR - FEET TOTAL DYNAMIC HEAD INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH ��� DIAMETER LIQUID DEPTH _ 3 - -- -- . Goulds p � -7 0+7 9 ■ j e Effluent Pump • 11 ca 3885 APPLICATIONS * Overload protection must smooth operation. Sulam ' can be operated continuously Specifically designed for the be provided in starter unit bronze irWIW available as without damage. following uses; g ■ Shalt; threaded, 400 series an option. �'� ■ Bearings: Upper and * Homes stainless steel. ■ C�ashW fast iron volute lower heavy duty ball bearing • Farms * Bearings. ball bearings type for maximum efficiency, construction. * Trailer courts upper and tower. 2" NPT discharge adaptable R Power Cable: Severe duty l standard e • Motels • Power co 20 foot f6r slide rail systems. `. rated, oil and water resistant. * Schools ngth (optional ■ Mecbardcal Seal: SUXON Epoxy seal on motor end Slagle ph * Hospitals lengths asebtej. CARBIDE VS. SILICON provides secondary moisture Industry : CARBIDE ice. barrier in case of outer jacket thre • Effluent systems • w ' HP — 1603 he Stainless steel metal parts, damage and to prevent oil with 115 V or 230 V e .,.N etastomers, wicking. prong plug. . S Gotrosion- resistant t 0 -ring. Assures positive SPECIFICATIONS %-11% HP —1403 ST® with Pump tam leauls stalrjiess steel. Threaded sealing against contaminants • Solids handling capabilities: Three phase: design. Locknut on three and oil leakage. YV maximum. • %-I K HP —14M STO phase models to guard • Discharge size: 2' NPT. with bare leads. On GSA against component damage AGENCY LISTINGS • Capacities. up to 128 GPM. fisted models — 20 foot on accidental reverse rotation. • Total heads: up to 123 feet length SJTW and STW ■ Motor.. Fully submerged in � O S � TDH. are standard. high-grade turbine oil for Mechanical seal. silicon lubrication and efli clent heat - carbide - rotary seatlsificon FEATURES transfer. carbide - stationary seal, 300 . Designed for Continuous series stainless steel metal • i��r Cast iron, semi- Operation: Pump ratings are Parts, BUNA -N el mers. op }nonce wit the molar manubcturer's * Temperature: out vanes for mechanical seat recommended working limits, 104 °F {40•C) continuous Protection. Balanced for 140-F (60°&) Intermittent. MET FM • Fasteners: 300 series 90 3885 stainless Steel. SUE W SOLIDS • Capable of running dry. zs eo rM VANous without damage to components. 70 t sFr _ Motor 20 Single phase: t * % HP, 115 V, 200 V, 230 V, 60 Hz, 1750 RPM; 91 lip, Z is 115 V, 60 Hz, 3500 RPM: N 40 %HP —I%HP, 230V, s 60 Hz, 3500 RPM. � 10 as * Built -in overload with automatic reset. * CIM B insulation. s Three phase. to * h HP —1'A HP 2001230! OL 0 460 V, 60 Hz, 3500 RPM, o t o 20 30 40 So W 70 so so ton Eta 120 t3dGPM * Class 8 insulation. L ; zo 3 0 M cnPAC" 0 1995 Goulds Pumps Ettectfve May. 1995 nzwwc + +a+l d • SOIL EVALUATION REPORT Pia o f --.��. OirWan a/S�iy�nd8uidegt oil "A►anpawawhaawAme tax I II . - imo4er.i'Iam" Cr "G �k .b + roti4�Itioc- 4ra6olYaor"wbrwrorooM O Ip vwoarRalofa�.sWlrona„ aoA� ar�IMR�IOC�hi�1M�II�a�bwrM1l. 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D Pit Qourdmwf..w. k Noma '�"°"`� !' .�► Wows eats � soft t s ebv. 1t b 8a Soler AL Qetri�t�t 1ll�oc��ew. two 8i"reirrt Aows lirteloi ChL S G1■It trllbr Glr: 9� T6a otC'�sodo� is as eq� opport Krvica ad owd .+ ' is as aileewe . pkare: cootdleat 1be If "a° °fed aka ""win at 608 - 2"-3151 or TlY 6083644Pn. ,�~� ,�`,��,,�,�,�*.. Sep i �v�.1��,-t`fl� ��►�+,. �#cs •sw ll -3! —1� A 8n1 l tee f �! j_' -© __•.rte -- _ �• __ ` _ 4001, .. .- _ J J _ y _ .. -.. ® k { V ft=wk Dnpwomdn f canmwm SOIL EVALUATION REPORT pop Lsrkion Of §d*NW BWkb s In aooardanaa win Comm 95, wk. Adn Cale Fftml@ dle abR an,P.psr nol Nas IAaa i ta x 11' ml In sha. Raa mM cmxh' st. Cr.o tk MWr, lad Ift niantnoe aatit q, dY�ios add p ul , p Id*kgobWdkvmWw mg „wuw WW �oaa+u�M o.aw t e © —t 5 _ _ POW” Print AN kwbnna & m ova �r..ri.+...w.y.... ....�r�....r+.e�a..e..+�nwira.« PIP* !h�('/� �� • // l � 0 r RG I to u«SLJWl s ; 31 N. R I( X oZ � © :. 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P S _ ` Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 s TDD #: (608) 264 -8777 �scons�n �� re www.commerce.state.wi.us /sb ` www.wisconsin.gov Department of Commerce s ��QZ Scott McCallum, Governor Philip Edw. Albert, Secretary t C r October 30, 2002 CUST ID No.220537 ATTN: POWTS Inspector ZONING OFFICE CALVIN W POWERS JR ST CROIX COUNTY SPIA 1969 185TH AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/30/2004 Identification Numbers Transaction ID No. 796933 SITE: Sit ID No. 651990 Jeffrey Johnson Please refer to both identification 2201 210th Avenue numbers, above, in all Town of Cylon correspondence with the agency. St Croix County SW1 /4, SW1 /4, S16, T31N, R16W FOR: Description: Three Bedroom Replacement Mound System Object Type: POWT System Regulated Object ID No.: 875465 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 Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01/01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD- 10706 -P (N.01/01). • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. CALVIN W POWERS JR Page 2 10/30/02 • Comm 83.22(7) - 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. F s Owner Responsibilities: • Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. Owner Responsibilities Continued: • The owner is responsible for submitting a maintenance verification report per Comm 83.55, that is acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Gerard M. Swim Balance Due $ 0.00 POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm jswim @commerce.state.wi.us WiSMART code: 7633 cc: Leroy G Jansky, , Wastewater Specialist, (715) 726 -2544 - 7 PO TS OWMM'S MANUAL PLAN rte„ � q ; FE �OIaRATiQM Owner PWlW t Septic Tait Capp d v fa NA a s Sspft TWA fiflttaftc rrrsf �, o NA Nyreb er of a.d .0 a —3 13 MA EfOmW rf f ar fi s" - joo o NA Nians of fsbW Facility U,*% 13 fu � Tank CaPW*Y i� O WA � flow IarrarapN ..3 Fulop Tank aCtlitrir c. a� D NA floe► (Perak!. Watirnstad x 1 .51 ' ' PUMP 1141smittclurer D NA Sad Raft pump No" 5/1 m i3 NA r Staraiatd M1r4terttJCfi4rsnt Ckn4tt IiAofhthly +N+Mq`9a' f% orememma Unit D NA Fats. Oil dr Grasso tFMI s30 wq& 0 SrAn VGravef (filar © Peat Hite# Wib�ml Oxygen Demand f9W j 5220! no& 0 NA 0 A49chanical Aeration 0 Vftft d Total Suspended Sows ITS% Slim WV& D Mdrdection 0 Odlor. Pwas wted Ehkm* OuOkv avrrrege J (aim meal U:adfsi ❑ NA fl!l dWftkcs Oxypsn Oenwnd M00j s30 n D brh Ipravity) ❑ in Ground �t TWld Suspended S� ITSSI S30 � © At -Grade Mrxrrhd Fecai Cats Wm 1psoetWe is eraeni SW cfW10mW D Drilf~l.irrs 0 Odhsr: Martirwtrnr E"Ime nt pal Size Y. die. 0". Q NA Otfitr•. Othm: 0 NA * Vafewe 00 !or d theme r aid arpelc tank aittkauet. 0 NA IM t 5trsuiaa. or t carhdh mt of Swrklsl At lost once evert: T in VO W - W wrw 3 - NA Fun" aut Comm" of tankew When aombirmad skudpe and aoum ettwkh awe -d" fX of © NA fewPoe diepsrtral cadbl At bow uses avow, t iNgafdieanrt 3 ors) NA -- -- - - - - -- fiM�sr 5 At Mdu orwca very: is volow - O NA b+apect #rump. PUMP cawarois A in I At #sect once every # ❑ NA Rust lamandg and pressure teat At IMrrt craps every: 3 � tstorr -bd 0 NA vow.: At khaat ma* every: D Q' NA 0 NA fM01�3iE di1�F?1WC1701�iS inuPectierfe of tarhlar and diaper" c0 t: afh" be made bv an audividwd conning one of the Ocomees or cartWicstions: iYi�ssarr f'luNrrber; 1i+EatAar Pkaaffitr N m d Sawa, POwTS bapec ; pOWTS iMrimmitiar; SafRapa SwViCIM Operator, Tank eertaK irwlrtde a viaa3at inspection of ow tswkfsl tv idwtdltr ant nisirp or brakort fhwdttrara6 idendtV any weeks or leaks, rehsaartev dte valurws of conrbfwed atydge afs spew( and to r* - ch for any beak up or p4 g of aiifbaent an dw pretend surface Tbo diapered PWW stall be vistwnr +b"Pengd to (stack the sl%ma Web In dw aflasrva tin rt pipes all to chm* for arty PandloD of affluent an din prayed surface, Tlhs partdirnp at;a#&DW t an 1M wound surface atey bodicame a to trq candl - 'n and ;requires 'the +en dieRa r od6catiaw of fhb tops roquisla swo "hen the combined Oc wnuIe"ow of lkm is and actrrn in any tank equals orw dwd IV or more of the tank vokmm. the entire AUDI IS of Om tankk shall be r rnoved by a Septe" Serviti g Operator and disposed of in accordance with chapter Nn 113, Wbm Adr inlearatiw Cod AN +other q@rvjcW bm*A V bum fiat irrritsei to the servicing of effluent fatem. mechanical or pressurized components, pretroutnis t cents, and ant servicing at intervals of S t2 fth mom chair be poto bV a c ili-d pOWTS iNsintmiewir. A service report Ohs" be Provided to the kma reguhtary + uomrity within 10 days of cornplation of ant service event. GAM f41011 w rAAT UP AND GPMMTX For now dwlt broads • prior exr we of the POWS dbsck Paw of the tww" •rdAw art tank for Prsr�ar of SYstam start Y a ar�� � high concentration a painting dOt � other # q ; Ourkv to ner auxap� *CCw when 8011 conditions are fusser► at the innitrat" surface. h av e the > +nsY f* abawe the PCftw to To ad situation ham � � t!M gii(at and t +er a r d'e' eua°`ss wa�rscar y� t result in ro effluent or a dents ai ft " ter renrpwed bye w r to r Leo not drive � Work rwlhir the over � tank. Pl<wrrrber 'or PaYVTS M�sirrer ep atsiet inin � Pu t within t5 feet dawn a im st ceNs. Oe not 41111" , Part ; or Otherwise any Reduction 1w of the eves disturb or Pact, the are: P01� r /�.,., .. ham d on _ fat m drain ft phi waesr; ' oaldorns, Ex ton swrabr "Prow the per(prm� and picking the WO Of th, PaWtmg Products; peeticides; sarritsry Peelings; hf lees: diaPo►s; drrfactanxa: fat; r A8ltgpp T ; and water softener brine. [ : fneditiations; Oil; the a nd S farts a� is irenrranently taken aut of s atdN y abarrda sarwrx, the )pElMryyy Shen t bt taltrr xo irratne that the sysxwn AN Piping to tanks and is rrce wndr thePttyr Conan 83.33. ill h=wjsln t�+dn� Code: a ' The convents of all tanks and Pits eh" � d the � � sallied. +emawrd and • After pRw�ir►8. an tanks arid Pits shah b• W"WIY disposed of by a Sefrtage Ssr . so7, WINVOi or arnodw itrert SOW �. and rernowed or "hair cowers rerrwved and the void strece Piped with PLAN N the PUM►T5 faNs and 1 3 A suitable sYstarrr: mot b rapsead tte " &'WWV messi have Oesrr, or rnwt be tarlcar, to provider a code car °n'enx aroe has Lsea dn,rA sd d for the bastion of a repisoarnent area should be Protected frordr and SON abs pitipsead rem* in the need for a new aoit, e+ stiorr to kit and sh dept be intrinOW b cornply with the rules in ed>r� at a nd time. establ i h a rape prove" ' �x ana wi O A suitable �t �s must art area is not sv i ebb due to w"ac�k armor toil 1► a holding tarA nwV be +"Stalled as a bat resort to r i'S, Sarrft advances in POWTS Q The Oft has not been err to . i replace fire failed Mav be installed as a last rssprE the � POW TSTS off no t area a ava labb a sod and site Mound and at -grade sail holding tank "I" be reconatr� in Place ifs swaos <WOAN h systerrre rr r tr y °M ' rat of the Wx wt at the 6 > ndes in effect at that tirrrt. SB ' O M- POW AND OTHHR T>lMA� T WE A SEPM. p!� on fi MAY COIMTA01 LETygI @ OXY ®tefll. DQ NOT UJOW f "NOM � TW R OF AA TAB T p�JLT OR � WA'" MAY "EBMT. PASCUE Of A XMrNMAL CoNNEM lira 1liiliTlitlEA Morris �+orre Ar tl l Y%-- l wry rS. NarneMANTA�!! 71S' ~�► fib �`.j Pfrorrt "Marne ATORY AuTmooM ° w+owe fMarrrei C)- O \A Oh was drslted wr �rwe „„iy, amPh- Ceawe 83 - 22f2)fhli r> th arrd 83. 1). (2) a 13). V101scr resin Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address je I 70'S ALe La., R t't h_M Q A S coo t` Property Address _ a o C (Verification required from Planning Department for new construction} i s� City /State Parcel Identification Number 00 �o " 0 c-) LEGAL DESCRIEIIQN Property Location - w %., S W %, Sec. to , T-..�JN -R I W, Town of C � . Subdivision , Lot # Certified Survey Map # Volume , Page # Warranty Deed # Qo ? 7 y _ , Volume 9 Sa Page # Spec house O yes PC no Lot lines identifiable Wyes 0 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, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewatadisposal system is in proper openfng condition and/or (2) after 'inspection and pumping (if necessary), dw septic tank is lei than 1/3 full of ahulge. Vwe, 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 Deft of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained trout be completed and returned to the St. Croix County Zoning Offrtx within 30 days of the three year expiration date. �:; SIGMA APPLICANT DATE OWNER CERTWICAEON I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of erty 8esc 'bed above, by virtue of a warranty deed recorded in Register of Deeds Office. �U OF J�/c,Elac4 K TURE APP LICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. ••"" Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certifted survey map if reference is made in the warranty deed 1952P y16 687497 KATHLEEN H. WALSH DOCUMENT N0. WARRANTY DEED REGISTER OF DEEDS ST. CROIX Co., NI RECEIVED FOR RECORD 08 -19 -2002 3:95 PM This Deed, made between Ilene A. Zielsdorf and Charles R. Krueger, as tenants in common, Grantors, and Jeffrey L. Johnson and Tina WARRANTY DEED L. Johnson, husband and wife, as survivorship marital property, Grantee, EXEMPT 11 Witnesseth, That the said Grantor, for one dollar ($1.00) and other REC FEE: 11.00 valuable consideration conveys to Grantee the following described real estate in COPYSFEE- 486.00 St. Croix County, State of Wisconsin: PAGESCOPY FEE: The Southwest Quarter of the Southwest Quarter (SWl /4- SW1 /4) of Section Sixteen (16), Township Thirty-one (3l) North, Range Sixteen (16) West. NIETRO LEGAL SERVICE EDIRET 362999 199094 WD 118271 ra RETURN TO'. ple Edina R Title, Inc. 3!0) ) , —i2 s• 40O X. Second Street, Suite 115 ` li son, WI 54016 d4 r w Parcel I D#: 006 - 1035 -20 -000 �+ Pd. $11.00 Ck. rr This is not homestead property. Together with all and singular the hereditaments and appurtenances thereunto belonging; And warranty that the title is good, indefeasible in fee simple and clear of encumbrances except easements, restrictions and covenants of record and will warrant and defend the same. Dated this 26th day of July, 2002. (SEAL) f.� (SEAL) Ilene A. Zielsdorf Charles R. Krueger AUTHENTICATION Signamre(s)ofllene A. Zielsdorf and Charles R. Kruegerauthenticat dthis ACKNOWLEDGMENT 26th day of July, 2002. DIANE Pv1. BARRON STATE OF WISCONSIN ) I 's. Nota y Fill ST. CROIX COUNTY ) Jeffery J. Drach, Esq. slate U , Personally came before me this 26th day of July, 2002, the above named TITLE: MEMBER STATE BAR•�Il� Ilene A. Zielsdorf and Charles R. Krueger, to me known to be the persons (!f not, who executed the foregoing instrument and acknowledge the same. authorized by §706.06, Wis. Stars.) THIS INSTRUMENT WAS DRAFTED BY Jeffery J Draeh, Esq. Not Public, State of Wisconsin. Drach Law Firm My commission expires: Jl a V a 500 Third St., Suite 202 Wausau, WI 54403 ( Signatures may be authenticated or acknowledged. Both are not necessary.)