HomeMy WebLinkAbout008-1035-70-050 (2) S T CRD�X COU NTY
PLANNING & ZONING
NOTICE OF VIOLATION
May 2, 2007
GRACE SOLUM
2623 50 AVE
WOODVILLE, WI 54028
Code Administration RE: Failing POWTS at 2623 50 Ave.
715- 386 -4680
Land Information & Town of Eau Galle- St. Croix County, WI
Planning Computer # 008 - 1034 -20 -000 Parcel # 12.28.16.174E
715 - 386 - 4674
Dear Mrs. Solum:
Real Property As required by the ST. CROIX COUNTY ZONING ORDINANCE, notice is hereby given that you are in
715- 386 -4677 violation of § 254.59(2) Wisconsin Statutes, COMM 83.32(1) Wisconsin Administrative Code, and
Article 12.1.F.4.d of the St. Croix County Zoning Ordinance. This Private Onsite Wastewater
Recycling Treatment System (POWTS) has failed under the definition in § 145.245(4)(b) Wisconsin Statutes
715-386-4675 (Category 1). This violation was first noted on May 2, 2007.
The violation has been documented as septic effluent discharging to a zone of saturation. An on -site
inspection conducted May 2 2007 verified that septic effluent was discharging to zones of saturation,
and to the ground surface. If fines and or forfeitures become necessary to bring about the abatement
of this violation, they will be assessed from May 2, 2007 in accordance with Chapter 145.12(4)
Wisconsin Statutes.
THE FAILING POWTS ON THIS PROPERTY POSES IMMEDIATE HEALTH CONCERNS AND
NEEDS PROMPT ATTENTION!
REQUIRED ACTION: A sanitary permit must be issued through this office. You have already
contracted with a certified soil tester (Clarence Glotfelty) to have a soil evaluation conducted. The soil
evaluation determines the type of on -site wastewater treatment system necessary, the required sizing,
and its location. You must then contract with a licensed plumber who will design the replacement
POWTS and apply for the sanitary permit. The POWTS must be replaced by February 1, 2008.
If you have any questions or concerns that I can address for you in this matter, please feel free to
contact me. Your cooperation in abating this violation is appreciated.
Sincerely,
Rya Yarr
Zoning Technician
cc: file
ST CROIX COUNTY GOVERNMENT CENTER
1 10 1 CARMICHAEL ROAD. HUDSON. W1 54016 715 386 FAx
E
commerce.wi.gov
Wisconsin Fund —
SC� S V Owners Private Onsite Wastewater
Application Treatment System
Department of Commerce Replacement or Rehabilitation
Safety and Buildings Division Financial Assistance Program
Instructions For Property Owners:
You may apply for a grant award for up to three years after you have received a TO l3E COMPLETED BY COMMERCE
determination of failure and after you have obtained a sanitary permit. Complete Part A of
this form, attach evidence of your annual income explained in Section #7, and return those
items to the sanitation or health department office in the county where the property is
located.
PART A. TO BE COMPLETED BY THE PROPERTY OWNER Please print.
Owner` Owner
Owner
Owner Owner
Owner
Address City, State, Zip Code
r
"Grant awards will be issued in the name and address of this If there are additional owners, attach documentation listing all - 1 owners.
owner.
1. Is this application for a principal residence or a small commercial establ shment?
(Complete both if applicable.) rincipal Residence
Smal Commercia
Establishment
If applying as a principal residence, do you occupy this residence 51 % of the year?
If applying as a small commercial establishment, do you own and occupy the small Yes No NA
commercial establishment?
If applying as a small commercial establishment, Yes No NA
r what is the name of the small commercial establishment?
Description of Small Commercial Establishment (farm, restaurant, etc.):
3. Has there been a change in ownership of the principal residence or small commercial
establishment served by the failing system within the last three years?
Yes No
If Yes elease explain:
4. As the owner, are you a licensed plumber or contractor engaged in the business of
installing private onsite wastewater treatment systems?
5. Will a portion of the replacement system be funded by another program? Yes N
Yes N
If es, explain:
6. How did you hear about the Wisconsin Fund - Private Onsite Wastewater Treatment System Replacement or Rehabilitation Program?
7. Evidence of income. If you are applying as a principal residence, attach a copy of your federal income tax return for the year of or
prior to the determination of failure. If you were married and filed separate forms, you must also include your spouse's return for the
same year. You must include evidence of income for each owner and for each owner's spouse. If you are applying as a small
commercial establishment, submit a copy of your federal profit and loss form for the year of or prior to the order or determination of failure.
If you or any owner listed above did not file an income tax return, contact your governmental unit for further instructions. Evidence of
income will be kept on file at the governmental unit and is subject to verification by the Department of Commerce.
Property Owner's Certification. I certify that, to the best of my knowledge and belief, the information I have provided on this
form and all attachments are true and correct.
Owner's Signature Date Signed Co- Owner's Signature Date Signed
Wes i 9-
PQ�sonal information you provide may be used for secondary purposes [Privacy Law, s. 15.04(1)(m)j.
St3D -9163 (R. 02/2005)
PART B. TO BE COMPLETED BY THE GOVERNMENTAL UNIT
I. VERIFICATION OF OWNERSHIP
On the document used to verify ownership, do the names match those on Part A of this
application? If no, please attach additional documentation explaining.
Yes No
kI e applicant answered yes to question 3 on Part A of this application, did the applicant(s)
the property when the order or verification of failure was issued or the system installed
incur the cost of replacement? Yes No
ument used to verify ownership: a (6`,, Document or Page
Number: 4 / 9 :5'7
1
public sewer available tothis property? Yes No
a previous grant been awarded for this property under this program? Yes No
. cipal Residence evidence of income. Please indicate applicable annual family income: $ Z 3 8 9 $
Federal income tax form �d` u , Line 3 , Year 2*0 OR Affidavit of
Year
Small Commercial Establishment evidence of income. Please indicate applicable annual gross revenue: $ ^--
Profit & loss form used:
Line Year
5. Date of the Order or Determination of Failure: _ M 4, Z
When was the existing failin system installed? Prior to 12 -1 -1969
4) 8W-9 d / 0( o //'70 12 -1 -1969 to 7 -1 -1978
Ss /iovG, y oc e g a, p (�w� s.Q.. 665.
Vertical di tance from the bo om of the existing infiltrative surfacE a limiting condition:
0 to Less than 24°
24 to Less than 36"
Equal to or greater than 36"
Private onsite wastewater treatme E l�a b discharge of sewage to (check all that apply):
Y):
r or roundwater ............. ...............................
......... ...............................
..........................
Category 1 aturation ... ..................... ...............................
........... ...............................
.........................
e of bedrock .... ...........
.................................................... ...............................
Category 2 The surface of the ground ........................................... ...............................
............ ...............................
Category 3 Back -up of sewage into the structure served .......................
7. This request is for what type of replacement system:
Conventional
If this request is for a system not listed at the right, please explain: Expenmental
Holding Tank
In- ground Pressure
C I _ Mound
8. Uniform Sanitary Permit Number 215 Date Issued s Z
O
Plan Approval Number N Date Approved
Experiment Approval Number Date Approved '-
9. After reviewing this application, I have determined the applicant to be:
Eligible
If ineligible, reason ineligible:
Ineligible
Govemmental Unit Representative's Certification. I certify that 1 have reviewed and verified all information provided on this
attachments and that they are true and correct to the best of m knowledge and belief.
gnature of thorized Govern mental Unit a esentative Title Date Signed
PART 1. GRANT FUNDING TABLES continued
G. Installation of a Replacement Exterior Grease Interceptor by Gallon Capacity.
Galion: tip to 1,249 1,250 -1,499 1,500 -1,749 1,750 -1,999 2,000 or more
G rant Amount: $550 $650 $750 $800 $900 $
H. Installation of an Experimental System. Amount Requested -
For Installation:
If you are requesting funding for an experimental system, please submit a copy of the Wisconsin Fund $
pre - approval letter along with a copy of the plan approval letter and experimental approval letter
containing corresponding identification numbers. Amount Requested
For Monitoring:
List the total cost of the experimental system and monitoring that is being requested separately at the $
right. Copies of paid invoices must be submitted with this request.
I. 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 showing the cost of
the item, and request 60% of the cost of the installation at the right.
TOTAL PART 1. $ Z,Z
t� ^
PART 2. GRANT AMOUNT CALCULATIONS
A Enter the total from Part 1. $ Z Z400 °
B. Is the applicant a licensed plumber or contractor who installs private onsite wastewater treatment
systems? If yes, enter 2/3 of the amount from section A or $4,667, whichever amount is less. $
If the applicant is not a licensed installer, ca the amount forward from Section A
C. 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 the amount in Section B forward to section F.
�[ If this application is for a principal residence and the annual family income of the owner(s) is
1, less than $32,001, ttus is the total grant award. Cant' the amount in Section B forward to section F. Z 2 a b
If this application is for a principal residence and the annual family income of the owner(s) is
between $32,001 and $44,999, list the amount in Section B here and go on to section D.
If this application is for an experimental system carry the amount in Section B forward to section F. $
D. Enter 30% of the amount by which the applicants annual family income exceeds
$32,000.
Annual Family Income
Subtract -$32,000
Subtotal X .30 = $
E. Subtract section D from section C. This is the maximum grant amount for this applicant.
Carry this amount forward to section F. (The amount in sections E & F must be at least —
$100 to be eligible for any grant award. If the amount calculated is less than $100,
enter $0.00 in section F. ) $
F. Total grant award requested for this applicant up to the maximum of $7,000. $ 2 d�
commerce.wi.gov Wisconsin Fund -
Private Onsite Wastewater
scons n Grant Treatment System
Department of Commerce Worksheet Replacement or Rehabilitation
Safety and Building Division Financial Assistance Program
Owner's Name: Governmental Unit:
PART 1. GRANT FUNDING TABLES
In Sections B -F, the number of bedrooms determines the grant award. To use the grant funding tables for small commercial establishments, divide the
estimated daily wastewater flow rate in gallons per day by 150, round off to the next highest whole number, and use the result for the number of bedrooms.
A - Site evaluation and soil testing. Grant amount $250. $ 250
B. Installation of a replacement anaerobic treatment component.
Number of Bedrooms Grant Amount
1 or 2 .................................................................... ..............................: ...........................$500
3 .................................................................... ............................... ............................550
4 ................................................................................................ ............................... 650
5 ................................................... :. ....... .......... .... . ............. ... ... ... .............. ...... ........... 725
6 .................................................................... ............................... ............................ 750
7 ..................................................................... ............................... ............................875 5 0
8 or more ............. .................................................... ............................... ............................950 $
C. Installation of a dosing component, lift pump or siphon:
Number of Bedrooms Grant Amount
1 or2 .................................................................... ............................... .........................$1,100
3 or4 ..................................................................... ............................... ..........................1,200
5 or more ......................................................... .................. ... ............ 1,250 $
D. Installation of a non - pressurized and in -ground pressure POWTS treatment or dispersal component.
Percolation Rate Design Loading
When Properly Filed Rate in Gallons
,)with the Governmental Per Square Each Additional
Unit Before 7 -2 -94 Foot Per Day 1 2 4 5 Bedroom:
Minutes Per Inch
0 to less than 10 .7 or mo $ 925 $1,200 $1,400 $1,450 $2,100 $250
10 to less than 30 0.60 to 0.69 925 1,200 1,400 1,800 2,175 250
30- to less than 45 0.50 to 0.59 1,375 1,550 1,650 2,000 2,225 300 ) L��
45 to less than 60 0.49 or less 1,375 1,900 2,200 2,250 2,275 300 $ / //
E. Installation of an at -grade or mound POWTS treatment or dispersal component.
Each Additional
Tyne of Desion 1 2 3 4 5 Bedroom:
At -Grade $1,975 $2,350 $2,350 $2,925 $3,025 $275
High Groundwater Mound 2,600 3,150 3,525 4250 4,775 300
High Bedrock Mound 3,300 3,850 3,975 4,500 4,725 350
'Slowly Permeable Mound 3,250 3,600 3,600 . 3,975 4,775 375
Mound with less than 24" of suitable $
Soil or greater than 12% slope, 3,050 3,450 4,000 4,55 4,550 375
* A slowly permeable mound may be designed using percolation test results property filed with the county before 7/2/94. A slowly permeable mound is
defined in s. Comm 83.23(1)(b) as having a percolation rate of greater than 60 minutes per inch and less than or equal to 120 minutes per inch, or having a
soil loading rate of 0.3 or less.
F. Installation of a POWTS Holding Component.
Each Additional
1, 2 or 3 4 5 6 7 8 Bedroom:
Grant Amount: $2,500 3,150 3,225 3,625 4,200 4,750 $400 $
Personal information you provide may be used for secondary purposes (Privacy law, s. 15.04(1 xm)).
SBD -9167 (R. 02/2005)
Wiscontin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety anrs Building Division
' INSPECTION REPORT Sanitary No:
506203 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Solum, Grace I Eau Galle, Town of 008 - 1034 -20 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
I4 , t C5- 12.28.16.174E
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV.
Septic, C Benchmark
�•1 X F.� , ' /amp 2 • �i 1oZ • `i /o�
Alt. B
Aeration C * Bldg. Seer t B 9 i 13
Holding �— St/Ht Inlet 1 • $5
1
TANK SETBACK INFORMATION St/Ht Outlet ��• Z• �Z•S
TANK TO kP f l WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic 146 11 1 7 Z/ 7Z Dt Bottom
Dosing _ _._ Header /Man.
Aeration Dist. Pipe , Z ,D 70 • 7
1
Holding - - - -- Bot. System 13- g
a 9 . e-wS
q ZG
PUMP /SIPHON INFORMATION Final Grade H J �T - �✓
Manufacturer De St Cove
� � 7 '�.
Model Number -
TDH Lift Friction Loss System Head T Ft
Forcemain Le Di_a�_. ist. to well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width / L ength No. Of Tre PIT DIMENZONS No. Of Pits Insid D� ia. _
Liquid Depth
�\
DIMENSIONS 7 6 Z � teJVC. . - " �
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: t
INFORMATION /► CHAMBER OR l J
Type Of S r` yste tiQ,^ 2 � �{p �SA • p�}- UNIT Model Number:
DISTRIBUTION SYSTEM ( 7 � J Zp, V
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Ai takF
Pipe(s) % A °
1 1-engt h Dia Length Dia Spacing �` •*.
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth of
1 xx Seeded /Sodded Mulched
xx
Bed /Trench Center Q • Q Bed /Trench Edges Topsoil .,y Yes No Yes No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: ! ! Inspection #2: /
Location: 2623 50th Avenue Woodville, WI 54028 (NW 1/4 NW 1/4 12 T28N R16W) metes & bou Lot P cel No: 12.28.16.174E
1.) Alt BM Description = pt V�-Q..�, C.r� J-•.�_ O�t� �' ��QC,
2.) Bldg sewer length = /�•,5�•� ('y` bJ QS
- amount of cover = 5 �_ - -� "� - - -� be—
Plan revision Required? Yes ')<
Use other side for additional information. ture J
L - -- J
Date Insepctor's na Cen. No.
SBD -6710 (R.3/97)
commerce.m.gov Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162
Von s i n Madison, WI 7 -716 Sanitary Permit Number (to be filled in by Co.)
Department of Commerce I oC
Sanitary Permit Applicatio State Transaction umbe
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the a riate; 4al A
unit is required prior to obtaining a sanitary permit. Note: Application forts for state -o ed P re Project Address ifdifferentthanmailingaddress)
submitted to the Department of Commerce. Personal information you rovide may be us ' r secondary
p urposes in accordance with the Privacy Law, s. 15.04 1 m , Stats.
I. Application Information — Please Print All Information j
Property Owner's Name Parcel #
MAY 2 4 2p07 0e) j_ /a3
Property Owner's Mailing Address i Property Location Pit r �h
a� ®, ST. CROIX CO�NTY Govt. Lot /��
City, State Zip ode
p A/#)'/., �'/", Section _ 0�
` _ 7 circle one
s
II. Type of Building (check � N; R Eor&J
. Al I that apply) Lot # �
❑ I or 2 Family Dwelling — Number of Bedrooms Subdivision Name /
`��� � (�0 ����Y:,v ✓/
[I mm Bloc k# I Public /Co
ercial — Describe Use C, ❑ fyt�of
❑ . ❑ State Owned — Describe Use CSM Number Yitlage of -
Town of t✓ Cr-tl ( G� Q__
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A.
❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
❑ Permit Renewal ❑ Permit Revision ❑ Chan a of Plumber List Previous Permit Number and Date Issued
B.
g ❑Permit Transfer to New r , an d �t Issued
Before Expiration Owner !
IV. Type ofPOWTS S stem /Com onent(Device: Check all that a 1 (,{J
Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. ofsuitable soil ❑ Mound < 24 in of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dis ersalfrreatmentArea Information: G
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) ; Dispersal Area Proposed (sf) System Elevation
� d� `/3 S 5
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units ��/ ` /,� v
New Tanks EEx =sting Tanks (/� /y /�/ 11 o 1 Y
/ k U in to
Septic r•1.1eMitlg�mdc_ � i x
Dosing Chamber
VII. Responsibility Statwuenl- 1, the undersigned, ass me responsibilit x fof installation ' he POw'1'S s 1 the attached plans.
Plumber's Name (Print) P ib Signature PR umber Business Phone Number
Plumber's Address (Street, City, State, ip Code)
`J Gl V1 l/\ 1 5� 9,5
VIII. oun /De artmen Use Onl
Approved ❑ Disapproved $ertnit Fee Date Issued ; Iss ' g Agent S' afar o v
❑ Owner Given Reason for Denial ✓ ,14110 -7 ;
,r.tbWreLlprovaUReasons for Disapproval r 3
1 Septic tank, effluent filter and
dispersal cell must all be serviced / maintained
as per management plan provided by plumber. / �j�`3—
2. All setback requirements must be maintained lll%%% .�L7/ 77 __t'"
' I " �lans for the system and submit to the Co my on paper of less n 8 x inch in size Wn'W,,
N �yyY�. Q �- ,a � � G��
SBD -6 8 .0 /07
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ence Glotfelty
U: lip
__...__.- P.nviro-Tecli Systems & Services�� Q
N4955 Sunny Hill Road / • . - a� ��
-° Weyerhaeuser, WI 54895 A/ r
. ASV t
_.....:._._....
•- — E eLt
(y
SYSTEM SPECIFICATIONS
t ,
In- ground Soil Absorption Component
Component Manual #
Project Name: __ SD 1.( M �S
Distribution Cell Type Septic Tank
Aggregate ❑ Leaching chambers[ Min. Septic Tank Vol. Req. gal.
Septic Tank Volume � gaff Z
Number of Bedrooms
� V W
Soil Application Rate (DLR) � Manufacturer - gpd /ft �,
(Designed Loading Rare) o ex)
Effluent Filter
Wastewater Quality
Manufacturer
Treated ❑ Untreated Model r 7
Combined wastewater: Pump Tank
Number of bedrooms Manufacturer
gal /day /bedroom x 150 Volume
Daily Wastewater Flow (DWF) = l_6D Model
Clear and graywater only: Distribution Component
Number of bedrooms Distribution Box [�
gal /day /bedroom x 90 Hydro- sputter
Daily Wastewater Flow (DWI-) = Other
Manufacturer
Blackwater
Number of bedrooms
gal /day /bedroom x 6 0
Daily. Wastewater Flow (DWF) _ J D
Dispersal Area ( te)
fe
(DWG (D
Dispersal Area (leachinm chambers) (
Leaching Chamber R 'k D
Cha size, EISA Rating
System sizing = DWF _ DLR = EISA
PWI-) PLR) (SA)
Diverter valve yes o
Manufacture
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larence Glotfelty ,
Enviro -Tech Systems &Services ,5/� o
N4955 Sunny Hill Road /
Weyerhaeuser, WI 54895 1 - r
�— j c:�
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
This is to certify that I have in pected the septic tank presently serving the
2 * 2 - � /! r(J� residence located at:
Z 1 /4, 4, Section 1Z ; Town Range /h W, Town
of , St. Croix County Wisconsin. Upon
inspection, I certify that I have found the tank(s), to the best of my
knowledge, will conform to the requirements of Comm. 84.25, and it (they)
appear(s) to be functioning properly.
Most recent date of service
Did flow back occur from absorption system? Yes No
(if no, skip next line.)
Approximate volume or length of time: gallons minutes
Capacity:
Construction: Prefab Concrete Steel Other
Manufacturer (if known):
Age of Tank (if Down):
(Licensed Plumber Signature) (Print Name)
(Title) (License Number) MP/MPRS
(Date)
Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes)
or licensed disposer (NR 113 Wisconsin Administrative Code)
Wiscorain Department of Commerce SOIL EVALUATION REPORT Page _ _ of3__
D viisipn of Safety and Buildings
in accordance with Comm 85 s. Adm. Code
County
Attach complete site plan on paper not less than 8 1/2 x 11 inches in s P must
include, but not limited to: vertical and horizontal reference point di a Parcel l_D.
percent slope, scale or dimensions, north arrow, and location and dis ce to t road. d Q 3
Please print aH information Rb D ate
Personal information you provide may be used for econdR B � ►EQL -w, s. 15. 1) (m)).
Property Owner P operty Location /7 q r- i/I ; /
MAY 2 4 L U U I IV 1/4 /4 S Z2 T a,q N R �Ip
Property Owner's Mailing Address L t # Block # Subd. Name or CSM#
ST. CROIX COUNTY
City State Zip Code ity rI Village Town Nearest Roaf1,
(�o av �e_ UJ I 1 1 R 1 5) - a3 5 t= au ZD ve,
New Construction Use Residential ! Number of bedrooms Code derived design flow rate GPD
Replaeemen oPu is or ncic�al -
Pare i I / lain elevation if applicab In • Ol- ft
and s ?DUFH ;CW '> ; e�l % b�Orfs "T� i �e a 5�icab dy t s r� - ' S1'0--C 4 ' 4 4-N �"ha�' is rnora {�i� I n ��¢, -A ire.
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F/-] Boring # D Boring Eg Pit Ground surface elev. • S ft. Depth tD knifing factor > /�5 in. Soli Appli Rate
i Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2
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Pit Ground surface elev. _,Lt _ ft. Depth to limiting factor 1 98 in. eii Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/lFF
in. M u \ nsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 `Eff#2
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Effluent #1 = B OD > 30 < 220 mg/L and TSS >30 < 150 M9 E#Lqt #2,= D < W mg/L and TSS < 30 mg(L
CS {Please Print) , CST Number reAACZ..., !ntoa igi"&— I ---- -
Address Date val Telephone
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Pd
dL - 7 a d - 11 IS - BIO&
Property Owner _ <::' 11 1ILA Vvn Parcel I D # _ Page ? of 3
F3 Boring # 13 Boring
54 Pit Ground surface elev. f a ,_L _ it Depth to limiting factor _ _ in.
Sal Applicatim Rate
Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2
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Boring # Boring
Pit Ground surface elev. / ft Depth to liming factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture SMucture Consistence Boundary Roots GPD/W
in. Munsell Qu. Sz Cant Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2
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Soli Appli cation Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2
' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mglL and TSS < 30 mglL
The Department of Commerce is an equal opportunity service provides find employer. If you need assistance to access services or
need material in an alternate format, please contact art*nt at 608- 266 -3151 or TTY 608- 264 -8777.
SBD.M3OTeA KO7 /00) '
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larence Glotfelty •�
................. ...... Enviro-Tech Systems & Services
N4955 Sunny Hill Road ��Q
Weyerhaeuser, WI 54895 :
i ............. �— LC �'o� IL
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Mailing Address A ve—
Property Address t�✓V��
(Verification required from Planning Department for new construction CL .
City /State � .Q ) oj)J j 11 QT Parcel Identification Number 7 V 0� l Q 34- 26—
LEGAL. DESCRIPTION
d k ' property Location. /4, �f � ' /., Sec. ��, TN -R Town of �=G� .
Subdivision Lot #
Certified Survey Map # 7 , Volume Page #
Warranty Deed # �q g7 - 7 � -- 7 , Volume _` R . Page # L11 3)
Spec house ❑ yes A no Lot lines identifiable A yes ❑ no
SYSTEM MAP= NANCE
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
masterplumber, Joumeymanplumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 full of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set fortis, 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 withm 30
days of the three year expiration date.
Ab, Ae-,
SIGNATURE OF APPLICANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of
the property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
_a. 41Z - O . l it i - k2q 107-
SIGNATURE OF APPLICANT DATE
* « * « *s ermit being revoked b * * * * **
Any information that is mss - represented may result is the sanitary p g Y the Zoning Department.
«« Include with 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
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ' of 2
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner 6L �
(fkh Septic Tank Capaci gal ❑ NA
Permit # Septic Tank Manufacturer ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units NA Pump Tank Capacity al Pa
Estimated flow (average) (fj� gal /day Pump Tank Manufacturer ❑ NA
Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer ❑ NA
Soil Application Rate Q 7 gal /day /W Pump Model ❑ NA
Standard Influent /Effluent Quality Monthly average* Pretreatment Unit
Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) <_150 mg /L ❑ Disinfection ❑ Other: /,� �J7 N�/
Pretreated Effluent Quality Monthly average =n-Ground ell(s) �!Y �.�i��/�/IZL�IEic N
Biochemical Oxygen Demand (BODd <_30 mg /L (gravity) ❑ In- Grb(ind (pressurized)
Total Suspended Solids (TSS) <_30 mg /L ® NA ❑ At -Grade ❑ Mound
Fecal Coliform (geometric mean) 510 100ml /1 ❑ Drip -Line ❑ Other:
Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA
Other: ❑ NA Other: ❑ NA
* Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once ever �� 3 ❑ me th(s) (Maximum 3 ears) ❑ NA
p y' ear(sl y
Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA
4 2, 3 Zl y6ar sl
Clean effluent filter At least once every: Z - Vi bnth(s) ❑ NA
S ��� ❑ year(s)
❑ month(s)
Inspect pump, pump controls & alarm At least once every: ❑ year(s)
Flush laterals and pressure test At least once every: ❑ month(s) 0 year(s)
Other: At least once every: ❑ month(s) ❑ NA
❑ year(s)
Other:
❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface.
The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of :512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
��
START UP AND OPERATION Page of
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at -grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
.required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
I The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
❑ Mound and at -grade soil absorption systems may be reconstructed iri place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with -the rules in effect at that time.
< < WARNING > >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name o �� Name &, o r
Phone Phone (� _ _
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name , 61V
Phone Phone
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Admmisuative Code.
e3
Cross Section of a Two Cell Inground Component
Using Leaching Chambers
Observation/Vent Pipes
Finished Grade =�
_ Finished Grade =
ft. Cell — +` —' - --
Slope % _ <� I Seperation
i
Ori al Grade_ '
Q
gam- - -- O riginal Grade
r Q 0 / �
Top of Chamber Top of Chamber = , 5
System Elev. _ !s• System Elev. = U l • Z
° Tireap ientAdDispetsal one.,.
Limiting Factor 1 gj(
Observation/Vent pipes to be constucted and capped with approved materials for the particular use.
Not to scale
��1 C'.- TgI�K '�. 5s S6>✓,-�'�iN I . - •S- y" Vern f
Cove-
4 min•
ItY GROUND LEVEL
A"
— --_ �
I
Approved Natei Approved
Tight Ga•e•ket j� �r �8 - 7 1 1 Hater -tigh
1I l I Gasket$ �
' I rr 1.11V 1 J
t
^---' CI S 1'V �1 E ,� Gradient' of
`Gradient of 1 I 5 11� � r Sewer Lateral
Sewer Lateral P ft'.
is 4" / ft. B AF FLC... OF Af'i'ROVEI)
AIATLI�IP,LS
RACKFILL riATLRIAL
TD Br- SAND-; .
6Fitva r,,.STzw S o� �7Aay /� .—
%UP.,P�LES Jt ;
I
1
Parcel #: 008- 1034 -20 -000 05/24/2007 04:14 PM
PAGE 1 OF 1
Alt. Parcel #: 12.28.16.174E 008 - TOWN OF EAU GALLE
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner
O - SOLUM, GRACE I
GRACEISOLUM
2623 50TH AVE
WOODVILLE WI 54028
Districts: SC = School SP = Special Property Address(es): ` = Primary
Type Dist # Description ' 2623 50TH AVE
SC 0231 BALDWIN- WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 6.000 Plat: N/A -NOT AVAILABLE
SEC 12 T28N R1 6W PART NW NW; COM NW COR Block/Condo Bldg:
THEROF, TH E 80 RDS, S 25 RDS, W 28 RDS,
NWLY 53 RDS TO PT 11 1/2 RIDS S OF POB N Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4)
POB EXC P174B & C 12- 28N -16W
Notes: Parcel History:
Date Doc # Vol /Page Type
08/28/2000 628932 1538/99 TI
07/23/1997 995/411 TI
07/23/1997 954/534
03/05/1993 495717 995/414 WD
2007 SUMMARY Bill M Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 05/12/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 27,000 93,200 120,200 NO
AGRICULTURAL G4 4.000 500 0 500 NO
Totals for 2007:
General Property 6.000 27,500 93,200 120,700
Woodland 0.000 0 0
Totals for 2006:
General Property 6.000 27,500 93,200 120,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch M 513
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
t 538PAGE 99
TERMINATION OF DECEDENT'S
PROPERTY INTEREST KATHLEEN H. WALSH
REGISTER OF DEEDS
DECEDENrsNAME ST. CROIX CO., WI
Carl Martin Solum A /K /A Carl M. Solum
ADDRESS OF DECEDENT AT DATE OF DEATH CITY STATE 21P RECEIVED FOR RECORD
2623 50th Avenue Woodville WI 54028 08 -28 -2000 3:30 PM
DATE OF DEATH sECURITY NUMBE TERM OF DECEDENT PRO
SOCIAL
03 -07 -2000 399 -36 -5516 EXEMPT If
CERT COPY FEE:
COPY FEE:
PRESENTATION OF DEATH CERTIFICATE TRANSFER FEE:
I certify hat I have viewed a certified co RECORDING FEE: 25.00
Y co of the decedent's death certificate. PAGES: 3
K41�,1 Pc-tl 45, A S 8 00
REGISTER OF DEEDS SIGNATURE DATE
Interest In property Is terminated under (please check appropriate statute): Recording area
s. 867.045 which pertains to property In which the decedent was a joint tenant,' Name and return address:
had a vendor's or mortgagee's interest, or had a life estate. *(You must provide a copy Grace Solum
of the document establishing joint tenancy or life estate.) 2623 50th Avenue
XX s. 867.046 which pertains to (1) property of a decedent specified in a marital Woodville, WI 54028
property agreement, and also to (2) survivorship marital property. (You must provide
a copy of the document establishing survivorship marital property.)
Presentation of recorded document establishing Joint tenancy, life estate, 008 -10 j4
survivorship marital property, vendor interest, or mortgagee Interest In real estate. —10, 0
L I - 20 -00 0N NUMBE
This document number is 495717 volume 995
page 414 of (check one) Records ✓ Deeds
Description of the real estate.
Include only the extant of ownership for vendor or mortoapee' interest) fn land at the time of the decedent's death H the extent of land is exactly
the same as on the document, a copy of that document may be attached to describe the real estate. The legal description of the property and the
persons receiving rho property are as follows: (N more space is needed, attach pages.)
Description of personal property (If any) being transferred.
You may list savings accounts, checking accounts and securities on attached pages. Indicate person(s) receiving property.
DECLARATION: I, we declare that this document is, to the best of my (our) knowledge and belief, true, correct and complete and Is in confor-
mity with the provisions and limitations of the Wisconsin Statutes. (If more space is needed, attach pages.)
Name and Address of Person Receiving Property Relationship to Decedent Signature (Notarized) Date
Grace I. Solum
2623 50th Avenue Spouse
WOGA-411e WT 541128 0a
lA,QFl1ggCONSIN, County of St. Croix
This document was drafted by: Sign e4 •. C,
(print or type name below) S'
g �l>ys
at�tp.bo' sb eon 8/28/00 by the above namedperson(s).
Grace I. Solum SrgrytrZr� �ererson
auth iced 05th
(as per
NOTE: SEE DIRECTIONS ON REVERSE SIDE Print o ETTE ORF
Wsconsin Reg k1w of Deeds Assmc Don Fern HT- 110(11/96) Title DEPUTY Date Dom mission expires 1/2/01
21516 (1 u961
VOL 1.538PAGFJ -00
DOCUMENT NO. STATE BAR OF WI£;.ONSIN FORM I — is" TM'■ erwcr eeeaeveD row wecowo.ue ew�w
495'717 VOL �► §9 p _.
F
!'S OFFICE Carl M. Solum, Clifford A. �Sol:m vrv l� o i iId_ "lubcI "; " "ti iiarit"a• "1'n" jjBCOId
- -_R ..... .... .. ...... ................ _._. . ..........._....._..._.__...... _.... _.__._....__......
rentor, 5 1993 (i cr; .. and " "s.n� R A. M
and....... C&L ........ .............................. ---- •••.......---_........_ .. . v ri y .................... .....I........................_ ...•
. .. ............. ............................... ................... ............................... dm►dO
...................... ............................... .............. ........... ................... grantee,
Wltnesso3th, That the said Grantor, far valuable conaldaration_.....
th:a dollar and .,thee valuable consideration
.. ............................... ------------ .- ..............
conveys to Grantee the following described reel estate to t . C20 (.x ws..sww m
County. State of Wtaconabt:
Part o` the Northwest Quarter of the Northwest Quarter
j of Section 12- 28 -16, described as follows: Commencing Tax Pareat No: --- ------
at the Norchwest corner; thence East dO rods to the
Northeast corner thereof; thence South 25 rods; thence West 28 rods; thence
Northwesterly 53 rods to a point 11 rods South of the place of beginning; thence
North on the West line of said Northwest Quarter of the Northwest Quarter, 11 rods
to place of beginning. Except: the West 25 rods thereof; further excepting: A
parcel of property in said Northwest Quarter of the Northwest Quarter described
ace follows: commencing at the Northwest corner of the Northwest Quarter of the
Nor ! Quarter of Section 12- 28 -16; thence East 25% rods to the point of beginning
thence East 160 feet; thet.ce South 348 feet; thence Northwesterly 160 feet, more
or less. to a point 300 feet due South of the poiut of beginning; thence North along
the East line of the Julius M. Johnson property 300 feet, more or leas, to the point
of beginning. Subject to easements and restrictions of record.
rRANSEM
S_[._. --1."
Elm
This .. ia.noe........... homestead property.
Ugo (M sot)
Together with all and sinrJar the handitamento and appurtenances thereunto belonsing;
And _._...__Gra or
nt........ -_ --• • -- ........ .••-----•••--------------•--•........ ............................... .
warrants that the title b good, indefeasible in fee simple and free and dear of encumbrances except highways,
easements, utility rights and reservations of record.
and will warrant and defend the same.
Dated this ......... 1 February ......................................... 1g ---
3_.
--•---- ._._..._...... des of ..................... . .
D ' Q.
..__.. ate `��`-- ....................... (SEAL) ............. ...._._._.(SEAL)
. Carl M. Solus C fford A. Solos
.......... -- ••• ..... .......... ................••_ -• .... .....
(SEAL) .. .. ... ......... ---- -- (SEAL)
Orville A. Solus Alf eda babel
ALIITMENTICATION AOILNOALEDGMENT
glssstare(s) .--- -•------ --------- --- -- --- -- -------- - -- -- STATE OF WISCONSIN
sm.
— - -- -•------ ----- ---- •-- » Y
Feb uar 93 •.... _! ' -- - --- - - ---- /
• t� _ /__ _.... lf._ ^_ Porsoaally came before m• . _day of
— •..... It►.l. tlta above nam
�un.i
;Iumn R. Schumacher ••.. r - °• •. - ° - -
T U_lf2uY1�_. �.:. �. A.brm.t- ------------------•---
----- _----•.---•-----•--- -- --•••--- ----------------------------
'TITLE: MEMBER STATE BAR OF WISCONSIN
-• ........ ..................•-•-_-- -•,• -- -- -°v
authortaad b7 ;?(16.06, Wig
to me me knowa to b,)h
aj•tililijM•,� ' V wie.e:ecuted the
fa as'oing lnstra4o* the Vame-
THI MNT WAG OnA•O •Y
B AK AKK NO RMAN. ►T RMAN. S . C. ------ - --- -_-.........
- °_...._ ».. Note Public - Cou nty . ..
.
v
e ....
�
�•- ---��1� t.�- �.'l_N. - - ........
---
Con W
tSisnatures may be aut>watleated or acknowledged. Both My C iar state expjRstion
a" net necessary.) date: . - - Qy-- • .. . . ..... . .)
He6 s at ewer dfw`r 1. ace, saeestgr ,aeat3 be woes er vrftbbl %4.— 0.6, frbw.
e►asaswrt oQa ata?s sVatr tM�1 xant wf R4 mr.a a 11 -