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008-1011-15-100
St. C~oiix County Planning and Zonin Detail Sanitary Information Monday, July 11, 2005 at 8:22:18 f1M Page 1 of 1 Computer #: 008-1011-15-100 SublPlat: NA Section: 4 Parcel #: 04.28.16.576 Lot: 1 TN/RNG: T28N R16W Municipality: Eau Galle, Town of CSM: Vol. 14 Pg. 3920 1!4 1/4: NE 1/4 SW 1/4 Owner: Uldrych, Ja 531 233rd Stredt Baldwin, 154002 State Permit: 430036 issued:. 05/02/20 3 POWTS Dispersal: Mound 24" or more suitable soi Permit: Renewa County Permit: 0 Installed: •-r// ~~/ C'S POWTS Detail: NA Bedrooms: 4 y~ ` ~~t ~ POWTS Pretreatment: j NA Notes / / ~ // b ec r As Built Plumber Other Requirements Not determined ', NA Hudson, Dale 1 G~ Sign ed Off: No Owner: Uldrych, Jay 531 233rd Street Baldwin, WI 54002 State Permit: 383981 Issued: 05/07/2001 POWTS Dispersal: Mound Permit: New County Permit: 0 Instatled: POWTS Detail: NA Bedrooms: 4 POWTS Pretreatment: NA Signed Off: No WI Fund: Additional Notes Monev Owed Temporary Holding Tank agreement received on $0.00 1/21/2005, to use tanks as temp holding tanks until mound can be installed. Jay Uldrych may be selling the property prior to mound installation. 1 informed him and sent him a letter stating that we would require the new owner to fill out the appropriate paperwork(holding tank servicing contract & temp holding tank agreement) also. (KG) W! Fund: Additional Notes Monev Owed $0.00 Notes Inspector As Built Plumber Other Reauirements Not determined NA Hudson, Dale \~~ irn~ Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buil~irig ~Oivision ~. ; - - INSPECTION REPORT GENERAL IMrORiVIAT30N - (ATTACH TO PERMIT) Personal information yciu provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)1• Permit Holder's Name: City Village X Township Uld ch, Ja Eau Galle Townshi CST BM Elev: Insp. BM Elev: BM Description: ~G A ° - ~v ~ , e., ~ ~ ~ c,s ~' f TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing ~ ~; ~Cr As~atisr~a Zw~ /~ ~~ Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~~/ Z O / o 3Z ~ Dosing It ,. , , ', t~ t J Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand S GPM odel Number , ~`,Q 3t1L ~ Lift Fricti n System Head TDH Ft Forcemain Length / Uia. p Dist. to well ~ SOIL ABSORPTION SYSTEM 'f~1QCH Width / Lengt~ ~ DIMENSIONS SETBACK SYSTEM TO P/L INFORMATION Type Of System: ouMd~ DISTRIBUTION SYSTEM '~ BLDG WELL / !!S / ? ~ ELEVATION DATA county: St. Croix Sanitary Permit No: 430036 0 State Plan ID No: Parcel Tax No: 008-1011-15-100 Section/Town/Range/Map No: 04.28.16.576 STATION BS HI FS ELEV. Benchmark ~, 3~ ~03~~ /b b AI;. BM ''1' Bldg. S wer ~,Zi ~3 St/Ht Inlet IZ, Ib ~Z, -t St/Ht Outlet Dt Inlet Dt Bottom I ~ , S~ $ , ~v 5 Header/Man. /d~ ` ~.~o ~!~/ Dist. Pipe ~ Ito ( 1 . bo $o p~.~ ! Bot. System 3t ~ Z. ~ ~~- Final Grade v~:1L ~. ~ ~ .IZ~ . St Cover ~~ 3.is 3.•s' ~~, is Cap- ~ • ~ S I PIT ~J LAKE/STREAM LEACHING CHAMBER OR UNIT Wt s~' Cl~ Q.Alt) . Depth Header/Manifold ' ` p Length ~ Dia 2 Distribution ~ Pipe(s) ~ Length . Dia / l~ ~ 2 [~ A Spacing x Flole Size t ~ ~~~ x Ho a Spacing ~~ /I Vent to Air Intake ~~i SOIL COVER x Pressure Systems Only xx Mound Or At-Grad S b0 "' C~sY~+1., Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ~ ~ , ~-i Yes ~, No r . , ~ .', Yes ='1 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ Z'~ / OS Inspection #2: ~ ~~ location: 531 233rd St. Baldwin, WI 54002 (NE 1/4 SW 114 4 T28N R16W) NA Lot 1 ~~~iS °~ Parcel No: 04.28.16.578 r1 "~ I 1.) Alt BM Description = g4~o~^- a~ 5 "~^ ^5 ~7 ' a t~ n,~s py~, pT' / S-r w.a~,~A'~T J 2.) Bldg sewer length = V I -amount of cover = ~ l~ Plan revision Required? ~ Y s ~'',j No Use other side for additional i rmation. SBD-6710 (R.3/97) ~ ~ ~~ ~ ~ i ,,'~"'~. ~/N/MNNNN ~.:_~ _~`_ MEMO : TO FILE January 10, 2005 ST. CROIX COUNTY WISCONSIN ZONING OFF=CE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-468U FAX (715) 386-4686 On Friday January 07, 2005, I received a call from Jay Uldrych. He owns a parcel in the town of Eau Galle, PID # 008-1011-15-100(57B). A mound permit was issued for this parcel with a state Sanitary Permit number of 430036. The mound has not yet been installed and cannot now be installed because of frozen soils. His question was two-fold. He wanted to know if a temporary holding tank agreement was completed and signed, could he use the system tanks as a temporary holding tank and if so, could he sell the parcel with the mound not yet installed. I told him he could use the tanks as a temporary holding tank if both he and a certified septage pumper signed the service contract. I also told him that we would not prohibit him selling the parcel, but the new owner would be also be required to complete and sign a new service contract with a pumper and the paperwork would need to be filed with the sanitary permit at the Zoning office. The mound will be required to be installed as soon as site conditions would allow it, no later than June O1, 2005. This information must be made available to the buyer. Mr. Uldrych also suggested that some money could be put in escrow to ensure that the mound would be installed as per the Sanitary Permit Approval. I would encourage this suggestion for the protection of all involved parties. Holding tanks are not allowed for new construction in St. Croix County under any circumstance. Temporary holding tanks are allowed only if weather and site conditions will not allow installing the drain field portion of the system. When site conditions are acceptable, the drain field must be installed as per sanitary approval requirements. Kevin Grabau Zoning Specialist QQ.-tnl! ~ ~,.e~ ~ ' Safety and Buildings Division County ` i m o ` m 201 W. Washington Ave., P.O. Box 7082 ( ~~ ~O~~,n Madison, WI 53707 - 7082 Sanitary Permit Number (to be filled in by Co.) De artment of Commerce (608) 261 ~'-.'.""" O 3 ~' Sanitary Permit Applieatio ~ te L .~Nu~m/b/er,, In accord with Comm 83.21, Wis. Adm. Code, personal information u provide ~l N (X may be used for secondary purposes Privacy Law, s I S.A4(t) ) ~ 11l ~ ~ `~ 20 o3ect ddress (if different than m 'ling adds) ~3~ ~~n~ rfj'~i^~7' I. Application Information -Please Priat All Information ~ZOna~IX ~,~~~ ~ ~ ~ ~ r Property Owner's Name U d Parcel Lot # Block # r ~ Property Ownet's in Address r~ in fir. Q~~~' ~ri v~, Property Location ',(1 Section ~ ~~` ~ ~~` City, State Zip Code Phone Number ~.~~~ ~t~-~l.S Lt.~~ ~/ D ~~,~~' ~.~ ~~ (y~0 ' i ' , .,,~fls N. R ~%~°E le w ~~asc Type of Building (check all hat apply) I I . _ ~ ~ , , , / Subdivision e CSM Num r ~ 'YS 1 or 2 Family Dwelling -Number of Bedrooms be ~ ~ ) ~ ~~ I ~. , ^ Public/Commercial -Describe Use m " ~,o r' ' 390 ^ State Owned -Describe Use ^City ^Village township of Q; ` III. T pe y of Permit: (Check only one box on line A. Complete line B if applicable) - A' ,~ / CI New S tem ys ^ Replacement System ^ Treatment/Flolding Tank Replacement Only ^ Other Modification to Existing System 8. Permit Renews ^ Permii Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner ~ ~ ~ a M Oy ~i;QO U 't- IV. T e of POWTS S stem: Check all that a 1 ^Non -Pressurized In-Ground ®'Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersaUTreatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation ` 00 - o ~ ~o0 9~ 3~ VI. Tank Info Capacity in Total Ntunber Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Ta Tanks Septic or Holding Tank v t O 1 ~ ~ ~r S Aerobic Treatment Unit vosing Civmber ~y /~v ,~ ~7r / / /~ ~es / ~' VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) _ Plumber's Signature ~ ~ lJ~ MP/MPRS Number ~3 ~~ 0 Business Phone Number 7i -l~~ - 3 ~'~ s . . O e umber's Address (Street, City, State, Zip Code) ~~ Sfre f '~lJ l i l~l ~ ~ f ~ i t t ~ f ~ C VIII. Coun /D artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued I I~sui Agent Signature ( Stamps) S urchazge Fee) ^ Owner Given Reason for Denial ~ 5C~ ~^ ~ ~Z~ 2eo3 ~ IX. Conditions of ApprovaUReasons for Disapproval I ~- `CCu.s ~%:~s,~ ~~--f~e.,et~ cam-- r"~~y Z ~ ?.ao3 . ~' W~ t, rs~?~-~ ~O.e_ ~-~st,.~h,.~~-e~Q 1~,, ,~,,t,H,,-~.er. ~T~nC1~s a~tr'~~+^ was v~c~e..t~-e~(t~t.wc P ~o~ . (J ~- ,~ 5~~t( r~~ c.~ Cam. S3 ' Attach compkte pleas (to the County oaly{for the system as p:per ant ku ~aa gl/2 x I1 taches !a size SBD-6398 (R. 08/02) /* Wisconsin Department of Commerce RRIVATE SEWAGE SYSTEM fs~r~ty ahd~Buildimgs.Division INSPECTION REPORT GENERAL INFORMATION ~ (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ^ City ^ Village Town of: Jldrych, Jay Eau Galle Township CST BM Elev.:• Insp. BM Elev.: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. vent to Air Intake ROAD Septic NA Dosing NA Aeration NA Holding PUMP /SIPHON INFORMATION . Manufacturer Demand Model Number GPM TDH Lift Lriction S stem TDH Ft Forcemain Length Dia. Dist. To well SOIL ABSORPTION SYSTEM County: St. Croix Sanitary Permit N o3ro 5 to Plan ID No.: 63 `,toy =T.~.ws. Io•~` arcel Tax No.: 008-1011-15.100 ELEVATION DATA STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer St/ Ht Inlet St/Ht Outlet Dt Inlet Dt Bottom Header /Man. Dist. Pipe Bot. System Finat Grade over th id De Li BED /TRENCH width Length No.Of Trenches PIT No. Of Pits qu p Inside Dia. ME 1 DIM N I Manu adorer: SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHING SETBACK CHAMBER N INFORMATION Type O OR UNIT um er: Mo a System: ~~«n~n~ rT~A\1 ~V~TCwA v~.~ ~ ^~wv . ^v.. r . r . ~ Header / Mani old ... Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SiDIL OVER x Pressure Svstems Only xx Mound Or At-Grade Systems Only / ' Location: 531 233rd Street, Baldwin, WI 54002 (NE 1/4 SW 1/4 4 T28N R16W) - 042816576 -Lot 1 1.) Alt BM Description = 2.) Bldg sewer length = -amount of cover = 3.) contour = Plan revision required? ^ Yes ^ No Usp other side for additional information. Date Inspecto~sSignature Cert No. SBD-6710 (H.3/'97j Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS' (Include code discrepancies persons present, etc~spection #1: / / Inspection #2: / - ~ ~ ~ 2 ~3 ~~J~CaII S~~ rttnent of Carrwrtoree ~Pe Attach tom f Sanitary Permit Application [n accord with Comm 83.21. Wis. Adm. Cock See reverse side for instructions for completing this applicarion Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04{!xm)J ete laps to the coon to onl for the stem, on a not less than 8 Safety & Buildings Division 201 w. Washington Ave. PO Box 7302 Madison, WI 53707-7302 (Submit completed form to county if not state owned. -I2 x 11 inches in size. County , n r p State P 'Number ^ if revision to previous application State Plsn I. D. Number `~~ b I. A Ilcation Information - Please Print sll Information Location: PropeAy Location Property Owner Name ~ 1 l I ~, ~i ~ 1/4 S~jl~l/4, S ~ T Q ,N,1~~ or Ply Uwtae~s ,~ Address Lot Num}ber Block Number I/~ +0 • GO ~ C3 ~ ~~~ 1 / , City, State > Zip Phone Number ~ 25- 505 sY~o~-S ~ '~Je lJ~ cJ ~~ Subdivision Name or CSM Number ~~'731~ , . , ~t II.~ype of Building: (check one) .i a.,s p•~ c~•~iw... ~~ 1 or 2 Family Dwelling - No. of Bedrooms :~ 4.mu~- ~]QW~S , ^ City ^_ ~}~auage j '['own of ~~ ~~ r/~ ^ pubticlCommercial(describe use):_ `~ `/ ` State-0wned Nearest Road ~~~ ~- 8 r x TS r ~ r nn µ ~r : I `. ~ r~ S /I Parcel Tax Number(s) pP8'..~1~//-/~ /r~Q III. T e of P rmit: Check onl one box online A. Check box on line B if a licable 5 6. ^ Addition to A) 1, 2. ^ Replacement 3. ^ Replacement of 4. Existin S em S stem S stem Tank Onl permit Number Date Issued B) ^ A Sanita Permit was reviousi issued ` ~ ~ ~ IV. Type of POWT System: (Check all that apply) d ^ Sand Filter M ^ Constructed Wetland oun ^ Non~cesstuved In-ground ^ Pressurized U-ground ^ Holding Tank ^ Single Pass ^ Recirculatin ^ Drip Line ^ Other: ^ At de ^ Aerobic Treatment Unit V. Dis ersaUTreatment Area Information: I Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soli Application 5. Percolation Rate ) (MieJinch) / ft /s Jd G l 6. System Elevatio~ Eleva o~e 0 ~ . ay q. a s Required Proposed Rate ( , ~ / ~` 4~ ~ ^ _ , ~~ 7 (~ 1 ~ tAao moo ~I~D ~, o / VII. Tank t=apacity in Total # of Manufacturer Prefab Con- Site Steel Fiber- Plastic Con- glass Information Gallons Gallons Tanks Crete strutted New Existing Tanks Tanks ^ ^ ^ ^ ~ ~~c ~._.~. /sera / e~j~ ©~ ^ ^ o ^ um ~ - 50 ~5~ I ~~ VIII. esponsibility Statement the undersi ed, assume nsibili for installation of the POWTS shown on the attached lasts. t Business Phone Number , Plumbers Namze (print~)/,J~ Plumbers Signature (no stamps): Mp/MPRS No. p ~ O f~_~ n Plumber's Address (Street, City, State, Zip Code) 9 IX. County/Department Use Only ^ Disapproved Sanitary Pemut Fee (Includes Groundwater Date Issued Is ing Ag`t Signs (No stamps) Q ~r~~ `~ Approved ^ Owner Given initial Adverse Su ge Fee) ~ '32,s i i ' ,, _p J.~ ?~ t ~ if on nat Detemt / ~ n ~r~ ^nnditio s of v` al /Re~assns fo D" apGpr~oval: ( ~t~ ~rtre~t true revtP~u.re/', r 1 1 , , n n . ~ D _ _~ _ t ~! - r.[~l~ _ ~... I, t1 OJ/ L„ t ,a~ ~-~ `1S ~~:~-1~t~.-E-~~. ~ ~ ,~ : a~ 386 ? ~ Sanitary Permit Application Safety & Buildings Division 3 J • •~- ~ , ~ ' In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. ~ Boa:7302 Q S ~ ~i~ '~Jiti~~ ~ See reverse side for instructions for completing this application oses ur r seconda d f Madison, WI 53707-7302 w , • ~ Department of Carrnneree p ry. p o Personal information you provide may be use s. 15.04(lxm)] [Privacy Law (Submit completed form to county if not , state owned. Attach co lete fans to the coon co onl for the stem, on er not less than 8 -iR x 11 inches in size. County , /~ ~ ~ . State S P 'Number ^ Check if revision to previous application State Plan i. D. Number `~~ I. A Iication Information -Please Print all Information Location: ion Property Locat Property Owner Name J ~ ~ / f pp J l ~ I /4 S,W l/4, S ~ T Q ,N, K ~ o< 'ling Address Property OWrtter's Lot Number Block Number r~ ^ City, State Zip Phone Number ~~~ts.'~~1: l~~ . SY~~.S ~.~ 25 - 505 Subdivision Name or CSM Number ~~'731~ II. ype of Building: (check one) .i a,t cv4»~.~ -~T ~/ ~ (g 1 or 2 Family Dwelling - No. of Bedrooms : ~~• y.~S . ^ Crty ^ illage r lB"I'own of ~~~ ~~ ~ /~ t ^ publicJCommercial(describe usc):_ State-Owned Nearest Road ~~~ _- , 8 , K T~,' ,"~^^"' ~ µ p ~ ~ . ~ "Sd~ Parcel Tax Number(s) ppg„ra/` ~~j'~ ~~ III. T e of P rmit: Check onl one box online A. Check box on line B if a licable 5 g . Jf ^ Addition to 6 . A) i, ew 2. ^ Replacement 3. ^ Replacement of 4. . Existin S stem S stem S stem Tank Onl Pemut Number Date Issued B) ^ A Sanita Permit was reviousl issued ~ [ ~ ~ IV. Type of POWT System: (Check all that apply) ^ Sand Filter ^ Non-pressurized In-ground Mound ^ Constructed Wetland ^ Sin le Pass ^ pressurized In-ground ^ Holding Tank g Treatment Unit ^ Recirculatin bi ^ A ^ Drip Line ^ Other: c ero ^ At de V. Dis ersaUTreatment Area Information: Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application S. Percolation Rate 1 6. System Elevation 7. Final Grade / Elevation 0 . Required Proposed Rate (GalsJday/sq. ft.) (Mielinch) /,(J ~ j , t / 97 `~Z 48-SZ / / l ' X00 Apo ~Ol~ /. o / VII. Tank Capacity in Total # of Manufacturer Prefab Con- Site Steel Fiber- Plastic Con- glass information Gallons Gallons Tanks New Existing Crete strutted Tanks Tanks ^ ^ ^ ^ um ~ . 50 ~.5~ 1 ~~ VIII. esponsibility Statement I, the undersi ed, assume res onsibili for installation of the POWTS shown on the attached lans. Business Phone Number Plumber's Name (print) Plumber's Signature (no stamps): MPJMPRS No. ~a l~, ~. ~u olsc~-.. ~. ~ ~4u.~--~- ~ ~ o ~ ~3 ~i - ~ ~ -33 Plumber's Address (Street, City, State, Zip Code) / 9 •~ IX. County/Department Use Only ^ Disapproved Sanitary Pemvt Fee (Includes Groundwater Date Issued Iss ing Agent Signer (No stamps) 'Q~ Approved ^ Owner Given Initial Adverse Su ge Eee)~ 0[) / ' Determination ~ M ~ Z'~ ~ ~ X. Conditio s of Approval /Reasons fo D' approval: ~'`^'~-' `r~ `y"""` r,evt~e~'. ~rrecc r -~ ` - t /~ w A ~ .~'~ ~lS C ~ ~` ,.~ ~E---- ~- Z3.3 ~~S-x.980 ~- ~~ 9s~o'_ 9.2.0 P: ~ by G..5~ «/ 1 ~ s~~dP~9°~y t ar : Togo oaf' / ",0. d, c . /o.pt. ~ //~/e~ / ~ o . Cf. Top off/ P./. C.~O,~aC I ----- - ----_ ~.L I 98.Q6 8I ~~` __~_ ,_ -~ 96 ~, ~'.. -' ~ .-' ~ Di~~ '~~ ~ ~'~ 9~~~ ~r~b` %~ ,. 9•Z•19~ Pao poses/ zS.3'X y'1.9G ~~'JOand -fwo(1J /a~r'cr-GS a~.Z'X7f!o. W/ ~8n0r'i~'000~Oe/li~s 9~,y, S~OQ~c.~+0.f2u. OyT ~~o pos eL !, ~,so/7so ~o.P. Corb,'~a-f, ~+-, ~'l~cr a E S.T ou.{~Te n (~oJ Fiz Pro~OOSed y 6 er~traow, 1~ 1 dwe.c~;h~ e ro csed ~~-~( P ~ 9z.83~a~ ede o~ ~cud,A~ve~ ? ~~' ~ + ~~ , _ . ~scons~n Department of Commerce Apri106, 2001 CUST ID No.220853 ATTN: POWTS Inspector Scott McCallum, Governor Brenda J. Blanchard, Secretary Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.com merce.state.wi. us/sb www.wisconsin.gov ZONING OFFICE DALE E HUDSON ST CROIX COUNTY SPIA 1416 220TH ST 1101 CARMICHAEL RD EMERALD WI 54012 HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/06/2003 Identification Numbers Transaction ID No. 634967 Site ID No. 628264 SITE: Please refer to both identification numbers, SITE ID: 628264, JAY AND JEANETTE ULDRYCH -above, in all cones ondence with the a enc . ST CROIX COUNTY, TOWN OF EAU GALLE; 531 233RD ST NE1/4, SW1/4, S4, T28N, R16W LOT: 1, SUBDIVISION: CSM VOL 14. PG 3920 FOR: DESCRIPTION: FOUR BEDROOM MOUND SYSTEM OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 787705 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • 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.O1/O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P (N.O1/O1). • 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. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound manual, and section VI of the pressure distribution component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • 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. • The changes made to this plan on 4/6/01 by this reviewer were acknowledge and approved by the system designer. • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). .DALE E 1dUDSON Page 2 4/6/01 . ~ >,~ ~~F • 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 hazazd. • Comm 83.52(3) 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. • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • 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. A11 permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, Charles L Bratz POWTS Plan reviewer II- Integrated Services (608) 789-7893, Mon.-Fri. 7:45 AM to 4:30 PM DATE RECEIVED 04/06/2001 FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 BALANCE DUE $ 0.00 cbratz@commerce.state.wi.us ~ WiSMART code: 7633 r .. MOUND SYSTEM DESIGN Residential Application INDEX AND TITLE SHEET tA~ q ~- ~j~ .off C~ 4 bedr m residential mound `~~ ` G Project Ja & Jeanette Uld ch oo ~ ~~ Owner Jay 8 Jeanette Uldrych ~~~n ~~~° Address 508 Co. Hwy. BB y~ ~~, Woodville, WI 54028 ~: Site Address: 531 233rd Street Legal Description NE1/4SW1/4, Sec. 4, T.28N., R.16W. Township Eau Galle County St. Croix Subdivision Name CSM Vol. 14, Pg. 3920 Lot No. 1 Parcel ID Number 008-1011-15-100, ID# 4.28.16.576 Plan Transaction Number Index and title sheet Mound calculations Mound drawings Pres. dist. talcs. and laterals TDH and pump tank drawing Pump specifications Site plan Turn-up detail POWTS management plan Attachment: Soil evaluation report License Number Designer Dale Hudson Signatuf~~.. L~'_ ~t,~rt~/ Date 3/30/01 Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 220853 Phone No. 71584-3378 Page 1 of 10 . -~ F~erformance Cures METERS FEET ~~~r~~rsil~6~ effluent ~u~~~s GPM m'/h .~~.3Dt~,PM. /'-'-i/I. Sc~P/~/~CCAPACITY ~ ~GOULDS PUMPS, INC. se~cA r~us r~w,~ Ewa METERS FEET i 120 MCI~FI '~RR~ 35 JILC %4 JUlIUS 110 WE15HH 100 30 80 25 ~ 70 = 20 J Ia„ 60 F- ~ WEOSHH 15 40 10 ~ 20 5 10 0 0 0 10 20 ~ 30 40 50 60 70 BO 90 100 110 120 GPM t i t i 0 10 20 30 m'/h CAPACITY ~ O ~ ~~ 01985 Goulds Pumps, Inc. Hective Juiy. 1985 ' s~ ~°/ p~9oU~I" 1.~. -Top aF ! ' P. /. CV.,o,;ac E 5'S- ~d 980, 9~- ~~ 9~0 ~_ 98.G~6 ~ '- ^ 3, ,,- qb• .- .- .- ~`~ "~ Ar~ ba"`~ ~ • D~S~ '~ / ~ ~'~ 9~~~ 9.Z.19~ 92.0 9,2.83 ~a ~ ede Off' ~ou.d,Gla,d~,~ pro posed RS.3'X f~'1.9G ~~'!ou•nd T'woG2J /a~dC,s at,z'X7S!o. soa ~ c.~ Qt z~.' i ` ~• ~-- I SD N~~waJ.,k~6a~ ~ . ~~ ~si _ - ~~/R C. ~/~be/ r~- ic1~ a~/u end ~;'lft/' a E S.T, Dcc.'f/t .Ten (io1 F«z Pro~O osed ~/ 6 Cdra~e,,,., dw ZC~-%n~ Qa~a~ e a ra osed ~e.C( P P 7 0~ ~ Access Box Threaded Plug Lateral ~ Manifold \\\~ Orifice\\\\\~ ~f/ Lateral turn-up detail Pg. 8 of 10 . ~ Mound System Management Plan . > Purst.tartt to Comm 83.54, Wis. Adm. Code General The mound septic system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD-10572-P (R.6/99}. All Local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. No individual should ever enter a septic tank or pump tank as dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manholes risers, access risers, and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The operating condition of the septic tank and outlet fitter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Pump Tank The pump (dosing) tank shall be inspected at least once every two years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System Trees or shrubs should not be planted directly on the mound. Plantings may be made around the mound's perimeter. The mound shall be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) on the mound is not recommended. Soil compaction may hinder aeration of the infiltrative surface within the mound and will promote frost penetration during cold weather months. Cold weather installations (October-February) dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220mg/L BODS, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. The pressure distribution system is provided with a flushing point at the end of each lateral. Each lateral should be flushed of accumulated solids at least once every 18 months. A pressure test should be performed with the results compared to the initial test taken at the time of system installation to determine if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring become defective the defective component shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location. Tce leakage will be eliminated by increasing the basal area of the system. Excessive ponding within the dispersal cell will be eliminated by removing biologically clogged adsorption and dispersal media and replacing said components as deemed necessary to bring the system into proper operating condition. Questions on theA~era`t~ion or+maintenance of the system sho/uld be dirE\cted to yo county zoning orlhealth inspect !JG 1cV $ f l t;'.~ r KcJ r.~~ v ~ ~) r 7 ~ ~ 5' `! ' ~. > ) `f ) }~ C~ :: i v~ (`) 1 5 J -3'1 ~ '~ yt'O 5 / S`T. C¢otlc ~`.o~Jri~lq Pg. 9 Of 10 2-'12-1995 8:©OPM FROM P.1 ' , ' ~~°;~~"~~ ~"8~~ `~'~'~ SOfL iA/ND 517'E EVALUATION REPORT Page i of 3 bivi~eien of Safety b (3w '~gy ~~....,, ....w .. un ~ ..~:_ w.i,...,_~_ Attach complete site plan en paper rwt Rtes then 81E2 x 11 inches in size Plan must irtdude but ~- ~'~~ , . not limited to vertical strtd heHzarttar reference point (8M), direction and % of elope, scale or PARCEL, , , M dimenaanad, north arrow, and bastion and distartoa to nearest road. bps-1011-10-000 ARPLICANT INFORMATION-PLEASE PRINT ALL INI~ORMATIpN aEVtt"wEDSY oaT!< PfiQPER7Y OWNER; PROPERTY LOCATION Richard & Robert Tot 3;'13011 ,GOVT. LOT NE to Sh1 1!4,34 T 28 ,N,R 16 ~E (a) W PROPERTY OWNk'~1':S (1MILING AOOSa~SS 508 t^by Rd "13B" LOT ~ BLOCK;k 3U8D. NAME OR CSM e . . 1 Clfl, STATE Z1P CODte P~IQNE NUM$ER QCITY ~YILLAGE ~0 NEAREST ROAD wooc9viile, WI. 54028 (715J684-342? ?tl New ConskUdion Use (x; Residerttia4 / Number of bedrooms 4 _ (; Addition b existing 5 (J Replaoernent (; Public or 40~nrtterCiai cee„saibe Cads derived daly Raw 6U0 gpd Aecofnmertded design loading rata • 5 bed, gib '~ rte, gpd/lt2 Absorption area required S00 bed, ft2 504 trench. R7 Mszirnum design roadir~g rate , 5 bed, gpdrit2 .6 trench, gpd/tt2 Recmttmended inCrltration su-laoe devatian(s} 97.40 h (as referred to arts plan t3endarttark) Additions! design I arts oortsiderations eYBtent ei. based . vn cczttoar 1 ins of a3.. '96.40' Pgrent «talerW aXacial drift Flood plain ek3vstion, if ap~pfic3ble nor R S ^ SWtAd@ for Sy$tenl t! - Ur-sugable tar rem CONVENTIpIWL D S ®u AAOUNO ~N-GROjJNa PaESSrJRE Ar.GRAD [$ S ~ U ~ S ®U ^ S ~9 U SYSTE~fit IN FK,L O S ®U _ HOLDING TANfc ~ S ~ U $C>IL ~LSCFtIPT10N REPORT Boring # ~~: ~~ Ground 91ev.. 94.45n. m fay 29" Boring ~ 2~ Ground elev. sd ~1 ft. ~~ iirt~ltlng factor 27" Horizon Depth i Qom+nantColor M ~~ Texture Structure ~C~ns~ster>ce Y Roots GPb/ft n. unseit Ch,. 5z. Cont. t:olor Gr. Sz. Sh. Bed T~ 1 0-7 10yr4/3 none 1 2~sbk doh cs 2f .5 .~.6 2 7-1fi 10yr5/4 ~ neue sit 2mabac a}sh gsr if .5 ~ .6 3 1b-29 5yr4/4 none sel 2irsbk dsh gar 1f .4 ;.5 4 ~ 29-45 5yr4/4 c2d 7.SyrS/6 sCi M nor tla. nor np ~.2 Qa.n ~.4e• 1 0-9 1ayr4/3 nano 1 Zmsbk clrsh as 2f .S .6 2 9-1b 10yr5/4 node ail 2~blt dsh ytr if .5 .6 3 16-27 5yr4/4 none. ~ scl 2msbk dt3h yw if .4 .5 4 2750 Syr4/4 c2d 7.5yr5/6 scl M nor t'>2t tza nP ' .2 Remarks: sizaaw,e: r-~ _ ..~'~ ~/l~"~ ua~: 12-7-9q CST Nambor: m07.298 . 2-12-1995 8:a2PM FROM ' PROPEfi1'OtiYM~#1 R• ~ R. Torereraon SOIL pESCRIPT1pN R EPORT' PkACEI I,R t aos-1011-10-000 Boring ~ Horizon Dspih ~. pomirtan; Gplor Munsell Mot>lea Qu Sz Qp~ ~ Texture SlrucWra C COn8i8~ f~JUf 3 `` 1. ..g 10yr4/3 . , , no~~ 1 r. Rr Rh 2ms?ak dah qw '.`~ ~ -1 ~ l Ox s ~/~ ~tc~ue s~J ~urBl~lc . dsl~ gAt Ground 3 5-25 5yr4/~! none ecl 2msbk dsh gw elev. 95~tt. 4 5-45 5yr4/4 c2d 7.Syr5l6 scl M rsa na ~~ ~ lirtxbng fr~r 25" Remarks: 3oring ~.J, t;rour~1 ~lov, -- ft. ~~ tirrH6ng IdCIOf 8ar.rtg ~ Gmurw ese~. - it I4 &rrr~rp ~tOr 9or!ng ~ Ground elev, tt. ~b Iacoor o , '~ Psp@? p{ 3 ., Roots ar .~ .b If .5 .6 1f .4 .5 na - np .2 ..r ..STEEL'S SOIL SERVICE Gary L' Steel Ri'chaxd ~ Robert Zbrgersan 1554 200th Ave. CSTM2298 t~sw~ s4-T26N-Ri6W New Richmond, WI 54017 MPRSW-3254 toara of Ea~a .(wile (715) 248.8200 lat #~-cs~t Phis soil t~vttit~bian eras ~~ to ~.itisfy a zoning regtilre»t, it may or may not Ise suitable t'dt your uat. The location of the teat may or may tAbt be as eboMn as per~narient lot lines t~+are not Qstab3.ished at the time the teat eras conducted. N 1"=40' amt.= top of 1" pwc pipe L e1. 2o0.00f Alt. BM.= top of 1" ;Pvc pipe ~ e1. 94.60' ~-Ic^"`¢' ~~ .~ ~~ GAry L. Steel 12-7-99 Wisconsii+ Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 ofi 3 LafJOf anc~luman Relations Dr!}isiorrof Safety & Buildings __a ...:.~. ~~ ~ m .,., .,~ a.~:_ na.., n,..a,. ~ 111 CIyVV~V ••,l„ ~L~ /~ a VV.VV, •.rv• •.v.... vvvv • COUNTY but Plan must include er not less than 8 112 x 11 inches in size Attach c ite plan on pa m let St. Croix , p o . p e s re ions~td% of slope, scale or not limited to vertical and horizontal reference point (B PARCEL I.D. # ~ q dimensioned, north arrow, and location and distan ~~iest-road. 008-1011-10-000 APPLICANT INFORMATION-PLEASE P NT~AtI IN~'~RAS.AT(ON `' ,~ ;; ; REVIEW`E_D(~Y SATE R. ~( /( La Lcod PROPERTY OWNER: ,"-' ` ' `• ~ PRO ERTY LOCATION Richard & Robert Tor erson ti fi ~ ~^:~") G6v7. LOT NE 1/a sW vas4 T 28 ,N,R 16 ~ (or) w PROPERTY OWNER':S MAILING ADDRESS -~ , - ~ ~ ~~ LOT BLOCK # SUBD. NAME OR CSM # 508 Cty. Rd. "BB" - ~"r '1' na csm CITY, STATE ZIP CODE PHONE NJ.,1QQl~ pFFI~ ' - ITY VILLAGE ~jfOWN NEAREST ROAD 3927 Woodville, WI. 54028 (715) 6~~ 23 ~c ] New Construction Use [ x] Residential / Numbef`ofi r' [ ]Addition to existing building [ ]Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate • 5 bed, gpd/ft2 •6 trench, gpd/ft2 Absorption area required 500 bed, ft2 500 trench, ft2 Maximum design loading rate . 5 bed, gpd/ft2 •6 trench, gpd/ft2 Recommended infiltration surface elevation(s) 97.40 ft (as referred to site plan benchmark) Additional design /site considerations system el . based on contour 1 ine of e1. 96.40' Parent material Glacial drift Flood plain elevation, if applicable na ft S =Suitable for system U =Unsuitable for s stem CONVENTIONAL ^ S ®U MOUND L~ S ^ U IN-GROUND PRESSURE ^ S ®U AT-GRADE ^ S ®U SYSTEM IN FILL ^ S ®U HOLDING TANK ^ S ® U SOIL DESCRIPTION REPORT Boring # 1 Ground elev. 94.45 ft. Depth to limiting factor 29" Boring # 2 ................. Ground elev.sd 97.1 ft. Depth to limiting factor 27" Depth Dominant Color Mottles Texture Structure Consistence Bour>d~ Roots GPD/ft Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. y Bed Trench 1 0-7 10yr4/3 none 1 2msbk dsh cs 2f .5 ~ .6 2 7-16 10yr5/4 none sil 2msbk dsh gw 1f .5 .6 3 16-29 5yr4/4 none scl 2msbk dsh gw if .4 .5 4 29-45 5yr4/4 c2d 7.5yr5/6 scl M na na na np ' .2 Remarks: 1 0-9 10yr4/3 none 1 2msbk dsh cs 2f .5 :`.6 2 9-16 10yr5/4 none sil 2msbk dsh gw if .5 .6 3 16-27 5yr4/4 none scl 2msbk dsh gw if .4 i .5 4 27-50 5yr4/4 c2d 7.5yr5/6 scl M na na na np ` .2 Remarks: CST Name:--Please Print Gary L. Steel Phone: 715-246-6200 Address: 1SS4 200th. ve. New Ric mond WI 54017 Signature: Date: 12-7-99 CST Number: m02298 PROPERTY OWNER R. & R. Torgerson SOIL DESCRIPTION REPORT, PARCEL I.D. # 008-1011-10-000 , Boring # ~> 3 Ground elev. 95.5 ft. Depth to limiting factor 25" Boring # Ground elev. ft. Depth to limiting factor Boring # Ground elev. ft. Depth to limiting factor Boring # Ground elev. ft. Depth to limiting factor Page ?~ of 3 . . Horizon Depth Dominant Color Mottles Texture Structure Consistence Baxrdary Roots GPD/ft in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 -9 10yr4/3 none 1 2msbk dsh gw 2f .5 .6 2 -15 10yr4/4 none sil 2msbk dsh gw 1f .5 .6 3 15-25 5yr4/4 none scl 2msbk dsh gw if .4 .5 4 5-45 5yr4/4 c2d 7.5yr5/6 scl M na na na np .2 Remarks: Remarks: Remarks: Remarks: SBD-8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Richard & Robert Torgerson 1554 200th Ave. CSTM2298 NE4SW4 S4-T28N-R16w New Richmond, WI 54017 MPRSW-3254 town of Eau Galle (715) 246-6200 lot #1-esm This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted.. N 1"-40' ffir1.= top of 1" pvc pipe C el. 100.00' Alt. BM.= top of 1" pvc pipe C el. 94.60' ~° ~~ ~~~ .r~~~~ ~~ O~ GAry L. Steel 12-7-99 ST CROIX COtlNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address Property Address c1Q y ~~/~~ v ~ r-- ~`.3l x.33 ,.err l~ooo~rso;~% ~ I~' (Verification rcquircd from Planning Department for new ~~ Ci /State //-) U tY -~~ (~G~~'-•.•, ~~7 °",. Parcel Identification Number Dab-~Ol/~/ - ~f.'Y} S.n # ~. ZS r /6. 7 8 1:,EGAL DESCRIPTION Property Location ~ %., S~1 y, Ste, ~ T ,~~ N-R~W, Town of ~Cre~t ~a~(G Subdivision Lot # I Certified Sarvey Map # ~ ~ ~ ~~ / ( Volume /~_ Page # 3 ~© Warranty Deed # ~ Z 9©5~.,3 Volume /~' Page # ~ t~ Spec ~oase [] yes [43 no Lot lines identifiable 111 yes ~ no SYSTEM -MATNTRNANCE - ImgllDpapSCandmaintmanrrpt'yO~~hCCOU~I~GSU~t1IIItSp~3tZi[C.~Qi1Ct0~Jd~CVif35ttS.PPOpCiII]dln~dnQC of pamping oat the septic tank evexy Qmx years or sooaw if needed a Iroensed ~ Y P~ into ~ m~ can sffact.th+e Enaction of the ~ - . P~Pa -What on septic taalc-as. a treatment stage is $ue waste disposal:systenr. Tfue pmpexty- owner agrxs to sabmit tp St. Qroi;c 7.oning DeparGmcnt i .cxrhfic~tioa form, signed by the ownac and ~r a ~~P7~Y~nPl~ resmictedplmmberoe a lic~pcm~ervcafying that (I) flue onsito wastewaterdisposal system is in proper opcxating condition and/or (2) after inspection and pamping_(rf noassary), the scptic~tank is leis .than Irafull of sludge. . ~, ~ mod have read the above r+cquir asd ague to maintain the private sewage disposal systemr with the standards sd forth, . -as set by ~ of Commove and tine Department of Natural Reno ~; State of Wisconsin.- Certifiextieia ~~S ~Y~ septic sysiam has bexa maintainAd mast be ooarple~ed and returned to the St, Croix.Cormty Zoning Office within 30 days of flue tbrce yrar cxp' tioa date. i3~ / Q/ OF PLICANT ATE OWNER CERTIFICATION I (we) certify that all statements on this form arc true to the best of my (our) IGnow[cdge. I (we) am (are) the owner(s) of the ~ dcscn'bcd above, by virtue of a warranty dead rooor+dcd in Itegista of Deeds Office. TUBE APPI:ICANT / / DATE «««««« Any information that is mis -~represeatod may result is the sanitary permit being revoked by tlro Zoning Department. rt««««« «« Inclade with this application: a stamped warranty dead from the Register of Dodds ofTce a copy of the certified survey map if r+efereace is made in the warranty deed Vli. 15J8PAGt 498 ~~ ' STA'rEBAROF~VISCONSINFORM2.1999 _ - Es29~'33 --- - - _ ___ _ - DocumentNumbcr WARRANTY DEED . KATHLEEN H. WALSH kEGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between RICHARD LOUIS TORGERSON 6 RECEIVED ~ RECD ROBERT TORGERSaR - OS-30-000 1:30 PN Grantor, and Jay Uidrych aad Jgaette Uldrych, husband and wife EXEMPT 5 0® ~T FEE: nta+sfER FEE: tD.oo RECORDING FEE: 10.00 Grantee. DRGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. CroLtt Camry, State of Wisconsin (if more space is needed, please attach addendum): a Lot One 1 of Certifed Survey Map in Volume Fourteen tt a~ of Certified tuvey M Page }g3ttf, as Document Number 6273 6 fi ed in St. Croix County Register o Office on Ju y eing located i4 the Northeast Quarter of the Southwest Quarter (NE %. of S W '/.) of Section Four (4), Township Twenty Eight (28) North, Range Sixtetn (1 ~ West, Town of Eau Galle. Reeordiog Ara name ao0lCewm AOCrcst Sti t5t00IWILLEY7iIlE > itlC• ~~>~ ~~~~ WYER FAlli, ~ 5/072 Ac -o y.G.t' 0o8-louao-ooo NfgA oag-IO[)-[ goo Parcel ]dahfication Number (PIN) This )soot homesteadpropcny Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. ~) ('snot) Dated this ~~~ day of August 2000 - - AUTHENTICATION Sigaaturc(s) authenticated this day of BARRON Personally came before me this ~ day of NE M. Angnst 2000 the above named Notary RIGHARD L I GER~~tOBERT • VYisCOnsin TORGERSON TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) msirument and acknowledged the same. TH1S INSTRUMENT WAS DRAFTED BY • _ , i~ ~~ Attorney Kristian t] ;!and Notary Public, State of Wisconsin Hudson, 1 My Commission is permanent. (If not, state expiration date: (Signawm may be authenticated or acknowledged. Both arc not necessary.) / ~. ~ ~~ ~:~ ~ ,) • Names of persons signing in any capacity must be typed or printed below thew signature. i„ra,,,,.i;o„ o„a.,~,,,r, ea„p„y,, yie m ~ ~ WARRANTY DEED STA'CEBAROFWISCONSIN air FORM No. S -1997 ~. 3 ~ Z,33 ~~ ~. ~~.,./at,G a td ~/ ' RICHARD LOUIS TORG S4 ACKNOWLEDGMENT STATE OF WISCONSIN ) ~• ST CROIX County ) • ~I 7 ~~~ CERT 1 F !ED SURVEY MAP LOCATED I N THE NE l /4 OF THE SW l /4 OF SECT ION 4, T. 28N. , R. 16W. , TOWN OF EAU GALLE, ST. CROIX COUNTY, WISCONSIN CURVE TABL F CURVE RADIUS LENGTH DELTA CHORD CH. BEARING TANGENT BEARINGS 7-2 5614. 58' 909. 13' 9° 16' 39" 908. !4' S82°48' 22. 5" E AT 1- S8T°26' 42"E AT 2- S78° 10' 03"E DESCRIPTION A parcel of land located in the Northeast'/, of the Southwest'/, of Section 4, 't'ownship 28 North, Range 1G West, Town of Eau Galle, St, Croix County, Wisconsin, more fully described as follows: Commeuciug at the Southwest Corner of said Section 4; tl~encc, South 8G°48'05" East, along tl~e south line of said Southwest'/,, 1306.99 feet; thence, North 00°24'14" East, 1318.91 feet to the southwest corner of said Northeast'/, of the Southwest'/,; thence, South 8G°52'45" East, along the south line of said Northeast'/, of the Southwest'/,, 58.65 feet to the easterly right of way line of 233' Street and the PO1N'I' OF BEGINNING; thence, Nor•tll 00°33'16" East, along said easterly right of way lirtc, 315.11 feet to the southerly right of way line of Interstate Highway `94'; thence, along said southerly right of way line and tl~e arc of a curve concave southerly, the long chord bearing Soutli 82°48'22.5" East 908.14 feet, having a radius of 5614.58 feet and an arc length of 909.13 feet; thence, South 78°10'03" East, along said southerly right of way line, 355.47 feet to the cast line of said Northeast'/. Southwest'/,; tl~encc, South 00°33'42" West, along said east line, 196.65 feet to tl~e southeast corner of said Northeast'/, of the Southwest'/,; thence, North 8G°52'45" West, along the south line of said Northeast'/, of the Southwest'/., 1251.89 feet to the point of beginning. Contains 7.90 acres or 344,213 square feet. Subject to any and all easements, right of ways or conveyances of record. SURVEYOR'S CERTII'ICATE I, James M. Weber, registered land surveyor, hereby certify: 7'I~at in full compliance with tl-c prvvisions of Chapter 236.34 of the Wisconsin Statutes and the provisions of the St. Croix County Subdivision Ordinance and under the direction of Richard Torgerson, I have surveyed and mapped the above described parcel ofland and that this map is a correct representation thereof. ~`gGOIyS~ Dated this ~ Z.~ day of 'M~~ , 2000. ~'~" ~ ~-z-';-~ ~ JAMES M. James M. Weber S-1804 3st~ot ~rRrro router. NELSEN-WEBER LAND SURVEYING, INC. ~.o_ ~ , MO'I'L;: 'emu lla The parcel shown on this male are subject to State, County, and Town laws, rules and regulations (i.e. wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel, contact the St. Croix County Zoning Office and tl~e appropriate Town Board for advice. 2000107A This instrument drafted by Jim Weber SIIEET 2 OF 3 Vnr.• Ih PArtt? ~o9r1 .~ CERT 1 F I ED SURVEY MAP L OCATED 1 N THE NE 1 /4 OF THE SW 1 /4 OF SECT ION ?, T. 28N. , R. 16W. . TOWN OF EAU GALLE, ST. CROIX COUNTY, WISCONSIN HIGHWAY SETBACK RESTRIC"PION No improvements or structures are allowed between the highway right-of way line and the setback line. Improvements include but are not limited to signs, parking lots, parallel driveways, wells, septic systems, drainage facilities, etc., it being expressly intended that this restriction shall constitute a restriction for the benefit of the public according to Section 236.293, Wisconsin Statutes and shall be enforceable by the Wisconsin Department of Transportation or its assigns. Contact the Wisconsin Department of Transportation for more information. NOISE The lot of this land division may experience noise levels escceding the levels in s.Trans 405.04, Table 1. These levels are based on federal standards. Owners of this lot are responsible for abating noise sufficient to protect this lot. ACCESS RESTRICTION CLAUSE As owner, I hereby restrict all lots and blocks so that no owner, possessor, user, licensee, or otl>Ier person may have any right of direct vehicular ingress from or egress to any highway lying within the right-of--way of Interstate highway `94', as shown on the land division map; it is expressly intended that this restriction constitutes a restriction for tl>le benefit of the puulic as provided in x.236.293, . Wisconsin Statutes and shall be enforceable by the departmcti>;t or its assigns. APPROVED ST. CROIX COUNTY Planning Zoning and darks Comminee JUL 3 12000 If ral recoAed within 30 days of approval date approval shall Ire null and voMl 2000107A This instrument drafted by Jim Weber t JAMES M. ~ WEBER s~.eo4 ~ VNLLEY~ Q~ O SURD 5 - _t7 ~ Q;~... -- z~.-off SHEET 3 OF 3 ~~r ~.~ ,. ~ ~ X000.. `~ ~ 0 9 ~~ ~~~ 12 CERT 1 F I ED SURVEY MAP LOCATED -N ~~ OF EAU GALLEE S~.I CROX COUN ~N WISCONSI~IV R. 16W., b SOUTNWES7 CORNER ~ ~ SECT ION 4 -FOUND D. O. T. APPROVAL q55-94-3060-2000 n ~ ALUMINUM CAPPED MONUMENT ' nv W . ~- I I ° o ;' ' ~°+ C. S. M.• .VOL.. 14, PAGE 3895 ( I ~ ~ «~ - ........... ................................ I p~ .. . ~ ~ 1 ~ WE57 LINE OF THE r1E-SW I - ~ _ ~ m f -w- ~- - - - - 1--- - -4- - - - ~7 - •233r•d o ___ ___ ~' ---13iB.s-' _W V1 O -~ STREET ~ ~ 315. 1 !' ` I - I- _ _ W Z m~, m $ ` I • O _ 1 ....... 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N 3 y~~ ~~ /. ~s~ ~ m Q K ~i~uhplptq-aYut~i~t~~V~`o SHEET 1 OE 3 2000107A THIS INSTRUMENT DRAFTED 8Y JIM 1NEBER RECE11/ED r~~ ~.`~~~ L. 1N N~NNNMN f..__ .l~__ MEMO : TO FILE January 10, 2005 ,1AN > ~ 2005 ST.C~ROIX ~CTOr~UNTY SZONING OFFICE ` VV ISCOIV ~711V ZON=NG OFF=CE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 FAX (715) 386-4686 On Friday January 07, 2005, I received a call from Jay Uldrych. He owns a parcel in the town of Eau Galle, PID # 008-1011-15-100(57B). A mound permit was issued for this parcel with a state Sanitary Permit number of 430036. The mound has not yet been installed and cannot now be installed because of frozen soils. His question was two-fold. He wanted to know if a temporary holding tank agreement was completed and signed, could he use the system tanks as a temporary holding tank and if so, could he sell the parcel with the mound not yet installed. I told him he could use the tanks as a temporary holding tank if both he and a certified septage pumper signed the service contract. I also told him that we would not prohibit him selling the parcel, but the new owner would be also be required to complete and sign a new service contract with a pumper and the paperwork would need to be filed with the sanitary permit at the Zoning office. The mound will be required to be installed as soon as site conditions would allow it, no later than June O1, 2005. This information must be made available to the buyer. Mr. Uldrych also suggested that some money could be put in escrow to ensure that the mound would be installed as per the Sanitary Permit Approval. I would encourage this suggestion for the protection of all involved parties. Holding tanks are not allowed for new construction in St. Croix County under any circumstance. Temporary holding tanks are allowed only if weather and site conditions will not allow installing the drain field portion of the system. When site conditions are acceptable, the drain field must be installed as per sanitary approval requirements. Kevin Grabau Zoning Specialist a ~~...~ CE11/EG~ BOLDING TANK SERVICING CONTRACT Contra Date J ,~~~~ `>, ! 2005 ~ ~ This contract is made between the ST. CROIx COUN rY Holding Tank Owner(s) Name(s) and Pumper's Name 'O1•J`5 5'~L.a~, """~ We acknowledge the instaNation of (a) holding tank(s) on the following property: (Provide legal descriptions:) S3 1 - Z'3 3 /ZD S"rTL,~6°'i' . !~ Atll w, ~ ~ li~,l .S~ 0 ~"~ 1. The owner agrees to file a copy of this contract with the local governmental unit that has signed the pumping agreement required in Comm 83.52(1)(c)1. Wis. Adm. Code and the approved Holding Tank Component Manual. This agreement will also be filed with the St. Croix County Zoning Department. 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantces to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintasn the access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local governmental unit that has signed the pumping agreement and to the County, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; f. The volume in gallons of the contents pumped from the holding tank for each servicing; g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with local governmental unit and the County named above within ten (10) business days from the date of change to this service contract. Owner(s) Name(s) (Print) ~AC.I ~ ~ ~~M )1~" 1 .~~MES ~ l N C ~~t ~, L.s~ st;~ cJ tom- ~ rte, s t p ~ ±v-r Pumper's Name (Print) Pumper's Registration Number ~ ~9~5 Owner's Subscribed and sworn to me on this date: /2~/a.~ a~ti~~~ Pumper's Notary Public S~idnature r v/" ~~ _ .., /.1. /lam ~ i7 y fit;:: ~':~ ,>~ ~~~~~i ~~~R~. * ~ ~~~~ .- :,J .^'' ~ ~ .~ ~~ ~~* ~ ~~~~~ Goer ~.,~~- S F~cpiration TDH and Pump Tank Drawing Total Dynamic Head Operational head 6.50 ft Vertical lift 17.22 ft Friction loss 0.11 ft Total dynamic head 23.83 ft Dose Volume Dose is > 8.8 times lateral volume t_ateral void volume 15.2 gal Minimum dose 133.8 gal Drain back 1.2 gal Dose volume 135.0 gal Are laterals the highest point in the system? Yes "X" here. 1~ "_~ If no, what is the highest elevation downstream of pump? Forcemain drain back to tank? ("X' one) x Yes No Typical Pump Chamber Layout In combination with state approved treatment tank. approved manhole cover with weather proof wraming label and locking device ~ ~ junction box ~ g~ IZ, ~~arade levels 4« vent Pipe ~ I electric as per NEC 300 and Comm 16.28 WAC waB of pump chamber or combination tank A alarm on pump on B pump 80.6 ft C off elev. D disconnect ~_ 3 " of bedding under tank Tank manufacturer Weiser Concrete WLP 1200/800-MR Com' Pump tank capacity 22.24 galrn Pump tank volume 800.64 gal Pump manufacturer Goulds Pump model number 3885 WE03M o A '~ B Alarm manufacturer Levelarm ~ C Alarm model number DLV 'p D Project: Jay & Jeanette Uldrych 4 bedroom residential mound Transaction Number: aRemate ' ~` outlet I location 18" min. ~-- approved ~ outlet joint Provide 1/4" weep hole or anti- siphon device as necessary Grade levels - pump tank manhole = 4" minimum above finished grade - vent = 12" minimum above finished grade 79.5Jtt Pump tank elevation at bottom of tank T/PC Inches Gallons 18.0 400.9 2 44.5 6.1 135.0 9.9 220.2 Page 5 of 10