HomeMy WebLinkAbout040-1152-50-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
578903 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:
Binder, Thomas or William I Troy, Town of 040-1152-50-000
CST BM Elev: Insp.BM Elev: BM Description: 2 Section/Town/Range/Map No:
`i (J — 3 ��� 23.28.20.589 590
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER . � CAPACITY STATION BS HI FS ELEV.
Septic I,A_ O Benchmark !Z�'q 0 I
�' ` �•-lad-r,-� l
KIJU— Alt.BM /` Go Z. /Z /62 .
FI�n.� �b � l^7
Aeration Bldg.Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet (o`Ic-7,
TANK TO J/L LD G. Vent t Air ntake ROAD Dt Inlet
Septic 3Z -, ft Dt Bottom
Dosing Header/Man. .7 q
Aeration Dist.Pipe -7- 1 07-Z-7
Holding i Bot.System 7• L 9� �7
PUMP/SIPHON INFORMATION Final Grade So la
Manufacturer Demand St Coverer Ip•
GPM C";1 o J Ga.� 715�I� Z.13 76 Z
Model Numb
df
TDH Lift Friction Loss Syste ad T Ft
Forcemain Length Dia. Dist.to Well
SOIL ABSORPTION SYSTEM 6, 17/1
BED/TRENCH Width Length , No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth
DIMENSIONS 36 Z —71�� �� "� __ `�
SETBACK SYSTEM TO P/L BLDG 1 WELL LAKE/STREAM LEACHING` Manufacturer:
INFORMATION CHAMBER OR "L F/.I v
Type Of System: , � 5 7 l t� > � �
�N1'� UNIT Model Number:
�A1 o 5 .�
DISTRIBUTION SYSTEM A.I IL F�a,f-,`.� �-3 (0 �v
Header/Manifold i f
Distribution lion � b J:` H@le Size x Hole Spacing Vent to Air Intake
� Pipe(s) .Jl �J"�
Length Dia_ Length �� Dia `'—Spacing �
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center 7 Bed/Trench Edges Topsoil Yes
No ., Yes No
COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2:
Location: 162 Cove Ct.(Catfish Bar)River Falls,WI 54022(S 1/2 NE 1/4 23 T28 R20W) St.Croix Beach Lot(4&5 Parcel No: 23.28.20.589 590
1.)Alt BM Description `�
2.)Bldg sewer length= !C�' �¢y e5z ,5 G f e,.J 5
-amount of cover= , (� n J w
2-61,.
8-3
Plan revision Required? Ej Yes No r n
Use other side for additional information. _
SBD-6710(R.3/97) Date Insepctor's ignature Cert.No.
l
County y
� ��m� Safety and Buildings Division Cr C
flfl Z 201 W.Washington Ave., P.O.Box 7162 Sanitary Permit Number(to be filled in by Co.)
p r Ov�j,` Madison,WI 53707-7162
--7
ovk 0?
anitary Permit X S'fi ation State Transaction �yer
In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit
is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address)
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary
u oses in accordance with the Privacy Law,s. 15.04(1)(m),Stats. 1(97- C.oVe C,+.
I. Application Information—Ekne Print All Information
Property Owner's Name / Parcel#
kltt"O,M sil�&,e 23. 2$ . 20 . 569 - 590
Property Owner's Mailing Address Property Location
2-100 1� at Jor ��e,. r l�r� Govt.Lot I
City,State , ^ Zip Code Phone Number p y<, /<, Section 3
µ�y1h�,►�`S O�\S 11`�1 N SrJ y ZZ (w )ssw"39/S (circle one r ��
T 2 8 N; R
2.6 E
ot�
II.Type of Building(check all that apply) Lot#
)-1 or 2 Family Dwelling—Number of Bedroo f�! .� Subdivision Name
lacQ e # !!! elrG�/`•
❑Public/Commercial—Describe Use Block 5�• G(D •)e! ❑City of
❑State Owned—Describe Use CSM Number ❑Village of
�
L7 d T Town of r0 y.
Z 10".6
III.Type of Permit: (Check only one box on line A. Complete line B if applicable)
A.
❑New System eplacement System ❑Treatment/Holding Tank Replacement Only El Other Modification to Existing System(explain)
B. ❑Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Owner
IV.Type of POWTS System/Component/Device: (Check all that appi ) 0
$Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑Mound<24 in.of suitable soil
❑Holding Tank O her Dispersal Component(explain) ❑Pretreatment Device(explain)
V.Dispersal/Treatl&nt Area Information:
Design Flow(gpd) Design Soil Application Rate(gpd o Dispersal Area Required(s Dispersal Area Proposed Spyn Elevation W.
J-0 ,. 5- 300 3,00 a 4 .0 6 �ll��,..
VI.Tank Info Capacity in Total #of Manufacturer
Gallons Gallons Units a o a o
New Tanks Existin g Tanks y o R
(� la(t�.► �� a U iz v1 it 3 fi
Septic or Holding Tank
VII.Responsibility Statement-1,the undersi ,a me responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name(Print) ! P imb s igna re MP/MPRS Number Business Phone Number
Tout, us s-t ��✓ G . I 22$y 6/ C�rs�y2s-ss vY
Plumber's Address(Street,City,State,Zip ode) J
'tJgZ�o 9(A5J,*,% Stream{ Rliv-ee Falls , t^!Z S402,Z
VIII. County/Department Use Only
Approved Permit Fee Date ssue Issuing t Signatur
X i5
iven Reason for Denial 75 V 7 ,
IX.CondidNATM for Disapproval
11. Septic ank,effluent fifter and 3
dispersal cell must all be sarvicss/rosintained
as per,management plan provided by plumber, I(` AAAp,6 /t1
s. Atood,w k tWements must 09 maintained / (J
per sppNcamie code 7 ordinirlcss. 5a ( Ga Jct_. ,
Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size
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RECEIVED
MAY 0 8 2015
ST.CROIX COUNTY
,OMMUNITY DEVELOPMENT
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name:
Owner's Name: ( J,L
Owner's Address:
--o
Legal Description: Z.3. Z_% . Zo • SFS�y Jr`�O
Township: !o
County:
Subdivision Name:
Lot Number. 4 4-5
Parcel ID Number. (5 L� `��jL 5o 0oc)
Page 1 Index and title
Page 2 Plot Plan
Page 3 System Sizing & Cross-Section
Page 4 Filter Specs
Page 5 Maintenance Information
Page 6 Management Plan.
Page 7 St. Croix Cty Septic Tank Maintenance Form
Page 8 Warranty Deed
Page 9 CSM or Plat
Attachments: Soil Test & House Plans
Designer/Plumber: Pa..) t J'¢�.`.�,� .� License Number. ZZ 54 5 1
Date: Phone Number
Signature
Designed pursuant to the In-Gr nd Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P(N.01/01).
Page 1
SOIL ABSORPTION SYSTEM DETAIL/GRAVELLESS LEACHING UNIT Page_of
Project Name: W l A l Q ry�
No.of Cells Per Cell
3 ft Cell Width _Total No of
tt Cell Length1 _sq ft EISA Per Cell
ft Cell Spacing sq ft Total EISA
Manufactu Model Laying Length EISA Rating
03H-5ft 5.0' 25.0
Infiltrator
EZ1203H- 10.0' 50.0
Gravelless Leaching Unit Manufacturer: z
Gravelless Leaching Unit Model:
Typical Cross Section
Finished Grade ft
Observation Pipe with
approved cap or vent
�a■
� ■'>i;i�i:i'.< i>:':i'::: :;<::is 'Ci<"::
■ a.: >>>: >>>>:<:._ Soil Backfill
Geotextile Fabric
117. G
r:i:•i:i:irl:i;i`<':':i`.<':;<'i;i;iSi'i<':i:i�. i'rr 1
Q Infiltrative Surface
12 in 0 it
ft Limiting Factor
--
Slotted and Anchored Ventl
---,WObservation Pipe with Cap
■.e...■■u■....... ...now..
Plumber/Designer Signature: k Cam,,,
License#: � 413-1 te:
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Page 2 of
START UP AND OPERATION
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.
i
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.
/ T
N aluati a o ingtank
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
<<WARNING>>
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL 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 JJ POWTS MAINTAINER
Name Name J re 7/"fly, �
e-t`ri h A
Phone 7 j�—_ L _ "L�/ Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name .5 c h c Name sT. CAW( C7V N 20M,0
Phone 71r yd 5-' — IP24 Phone —](5 3e(o_
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.5411), (2) &(3), Wisconsin Administrative Code.
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner W11111a 11t rn �r Septic Tank Capacity 7 ® gal ❑ NA
Permit# Septic Tank Manufacturer r iue-s Co ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer &9/v ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model/ ❑ NA
Number of Public Facility Units ONA Pump Tank Capacity gal ,?�NA
Estimated flow (average) gal/day Pump Tank Manufacturer J9 NA
Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer 9 NA
Soil Application Rate „ gal/day/W Pump Model ANA
Standard Influent/Effluent Quality Monthly average* Pretreatment Unit JPTNA
Fats, Oil &Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BODE) 15220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) :5150 mg/L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BODS) 530 mg/L 4 In-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) :_30 mg/L ❑ NA ❑ At-Grade ❑ Mound
Fecal Coliform (geometric mean) :_10°cfu/100ml ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size %8 in dia. ❑ NA Other: ❑ NA
Other: ❑ NA Other: ❑ NA
*Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event I Service Frequency
❑ month(s) (Maximum 3 years) ❑ NA
Inspect condition of tank(s) At least once every: 3 ,® year(s)
Pump out contents of tank(s) When combined sludge and scum equals one-third (%3) of tank volume ❑ NA
At least once ever ❑ month(s) (Maximum 3 years) 13 NA
Inspect dispersal cell(s) Y: ;Zyear(s)
❑ month(s1 ❑ NA
Clean effluent filter At least once every: 2(year(s)
❑ month(s) NA
Inspect pump, pump controls & alarm At least once every: ❑year(s)
'❑ month(s) J.NA
Flush laterals and pressure test At least once every: ❑ year(s)
Other: At least once ever ❑ month(s) ❑ NA
Y: ❑ 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 teaks,
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 (%3) 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.
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
p J/ OWNERSHIP CERTIFICATION FORM
Owner/Buyer �i(/L `C �' wt., d e r
Mailing Address Z 7 00 t a!D 1'' /vU 44 de, (d a� LA d k N
Property Address Lo y e- Cb UJ'{L
(Verification required from Planning&Zoning Department for new construction.)
City/State L u d S o k L) J' Parcel Identification Number 04-0
LEGAL DESCRIPTION 5'% 16
Property Location 1/4, 1/4, Sec. T ON R X,0 W,Town of �'y
Subdivision Plat: ,Lot#
Certified Survey Map# ,Volume ,Page#
Warranty Deed # (before 2007)Volume ,Page#
Spec house OyesElho Lot lines identifiable❑yes0no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
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. Owner maintenance
responsibilities are specified in§SPS.383.52(1)and in Chapter 12-St.Croix County Sanitary Ordinance.
The property owner agrees to submit to St.Croix County Planning&Zoning Department a certification form,signed by the
owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on-site
wastewater disposal system is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is
less than 1/3 full of sludge.
I/we,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth,herein,as set by the Department of Safety And Professional Services 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 Planning&Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s)of the
property described above,by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedKooms
A, d Ad-4
SIGNATURE OF APPLICANT(S) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department.***
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV.04/12)
Property Owner Parcel ID#_ `�' 7, 0 (
, t Page of 3
F3-1 Boring#
[�] Boring i
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. `Eff#1 •Eff#2
1 &,7 /0Y 3 .i nP 5 f It'l vfl 3vfr
- h Mr V ro a ufy
F-1 Boring# ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. `Eft#1` 'Eff#2
Boring# ❑ Boring
F-1
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. `Eff#1 `Eff#2
`Effluent#1 =BOD,>30<220 mg/L and TSS>30<150 mg/L `Effluent#2=BODS<30 mgA-and TSS<30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
SBD-6330(R.07/00)
r'
Wisconsin Department ofCommerce SOIL EVALUATION REPORT Page � of -3
Division of Safety and Buildings
in accordance with Comm 85,Wis. Adm. Code
®raer County i
' Attach compl not less than 81/2 x 11 inches in size.Plan must
include d to:ve ' I and horizontal reference point(BM),direction and Parcel I.D.
percen scale or�i ns,north arrow,and location and dish tp a sl d. V0 2 - - G �C.tr1U
�Q 2
S Pi k f°� Revte
p� ,
Date
.
Personal informatio C Y 1be
used for secondary purposes(Privacy
Property Owners - Propa"cation� _
Govt.Lot,J T/'4 i:�1/4 S 2-3 T Z S N R -E,(or)
Property Owner's Wiling-Address tit#' Block# ubd. N,amb or CSM#,
2- ojoe.. C
City State Zip Code Phone Number ❑City ❑Village Town Nearest Road
(.6-L 5zl-39 9 5 r
ALI
❑ New Construction Use:❑ Residential/Number of bedrooms Code derived design flow rate A�6 GPD
Replacement ❑ Public or commercial-Describe: i
Parent material Flood Plain elevation if applicable ft.
General comments
and recommendations: -T/Yr;.i, c'V-y
F-il Boring
Boring# ��/
�J Pit Ground surface elev. ft. Depth to limiting factor�77 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GOD/ft'
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 'Eff#2
3 I—) &re G ,'1 1 M h yt,
At ?p-�q S h tit �� n
F-T --T-
W Boring# Boring p
❑ Pit Ground surface elev. ! ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2
- . -1LP a YR Y S i sbh u "r ti' .a
7-5.Z LO Y.4 s r' sb � •�� /•
*Effluent#1 =BOD >30<220 mg/L and TSS>30<150 mg/ 'Effl ent#2=BOD <30 mg/L and TSS<30 mg/L
CST Name (Pse Print) Sign u CST Number
(P se C irfn, e as 5-1
Address DO Evaluation Conducted Telephone Number
3o 17 r
l
Property Owner f Parcel ID# �, Page of �-
❑ Boring#
Boring f
❑ pit Ground surface elev. y ft. Depth to limiting factor> �3t— in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft=
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Etf#1 'Eff#2
1 r9-7 �aY 5�h A VIP GW -3 v
7- h4 V 0 a vfr .
Boring# ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1" 'Eff#2
Boring# Boring
F-1
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'E1ff#1 'Eff#2
I
i
`Effluent#1 =BODS>30<220 mg/L and TSS>30<150 mg/L 'Effluent#2=BODS<30 mg/-and TSS<30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
SBD-8330(R.07/00)
Ryan Yarrington
� From: Monica Steiner <monica.steine,@steinehncmet>
Sent: Wednesday,April UO 201510:05 AM �
To: RvanYarhngton �
Subject: RE: LUO8S2D Binder RivenwayPOVVTSreplacement
Good morning Ryan, �
VVe will plan on going from 2, ZE/trenchesto2, 80/.Thank you. �
�
Monica
Steiner Plumbing, Electric&Heating �
N8230945`''Street
River Falls, VV| S4O22
715.425.5544 �
From: Ryan Yaninoton
Sent: Wednesday, April O8, 2O159:24AM
To: Monica Steiner
Subject: FW: LU88538 Binder Rivenway9OVVT8 replacement
Paul,
On the Binder septic you have the loading rate at a .5 (150 gal per day/0.5 loading rate 300 sqft)which will require an
additional 1OftofEZFlows. 5o you will need 30t for each trench or6EZ Flow sections.
Thanks
Ryan
From: Ryan Yanington
Sent: Wednesday, April O8, 2015 9:21Ay4
To: ; ;
Subject: LU88528 Binder RivarwayPOVVTSreplacement
William Binder Land Use Permit for a replacement septic system in the St.Croix Riverway District.
Thanks
Ryan Yarrington
St.Croix County Land Use Specialist
715'886'4680
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ST. CROIX COUNTY
WISCONSIN
- - ZONING OFFICE
r r r r r r■ r■ ■rrri ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
t - - Hudson, WI 54016-7710
(715) 386-4680
f .
August 5, 1996
Tom Binder
4209 Morningside Road
Minneapolis, MN 55416
Dear Mr. Binder:
On June 18, 1996, on the property described as Lots 4 & 5, St.
Croix Beach, Town of Troy, a code complying holding tank system was
installed. The existing 1,000 gallon septic tank was retained to
be used as a holding tank, and a new 1,000 gallon tank was added.
The holding tank was installed by David Fogerty, MPRSW No. 3289,
and was inspected by Mary Jenkins, PLBG2 No. 4626.
Should you have any questions, please contact this office.
Si cerely,
Mary J. Zen ins
Assistant Zoning Administrator
cc: File
Z~
F7-
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER f'(~/~ r'~lI~EIZ
ADDRESS
EAgiN of ~r/N S S' y~
SUBDIVISION / CSM# LOT
SECTION_,Z.7_T 41_N-R ,ZD W, Town of ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITJ IN 100 FEET,OF SYSTEM
Yb
-vQVr PITT
O
INDICATE NORTH ARROW
d
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
~z,v~2
4 t
3 BENCHMARK:
o~ ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER HOLDING .TANK INFORMATION
Manufacturer: T',j C Liquid Capacity: / ~0:51
Setback from: Well-_ House Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location .,(/yl
-SOIL ABSORPTION SYSTEM
Widthi'`~-~ Length Number of trenc
Distance & Direction to neare line:
Setback from: House Other
ELEVATIONS
Building Sewer ST Inlet: ST outlet.
PC inlet /p y. Y3 ~ PC bottom_~ y4~ Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade,
DATE OF INSTALLATION:
PLUMBER ON JOB:
LICENSE NUMBER: J,;L~f
INSPECTOR:
3/93:jt
Wboi'- Cfurnan en`ofIndustry,
• Labor an nd Human Relations
PRIVATE SEWAGE SYSTEM County:
Safety and Buildings Division INSPECTION REPORT ST. CROIX
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Permit Holder's Name:
BINDER, TOM ❑ City ❑ village Town of: State Plan o.:
CST BM Elev.: Insp. BM Elev.: BM Description:
Parcel Tax No.:
TANK INFORMATION LEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS Hf FS ELEV.
i
Septic Benchmark
Dosing
Aeration Bldg. Sewer
Holding -~-~C St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake c~
Septic i AX NA Dt Bottom
Dosing NA Header if Man.
Aeration NA Dist. Pipe
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand '
Model Number GPM
TDH Lift Fri ti System TDH Ft
Forcemain L gth Dia. Fi Dist. To well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length o. Of Trenches PIT No. Of Pits Ins" Dia. Liquid Depth
DIMEN I N DIMENSION
SETBACK SYSTEM TO /L BLDG WELL LAKE / STREAM LEACHI Manu acturer:
INFORMATION Type o CH BER
System: -eR UNIT Mode Number:
DISTRIBUTION SYSTEM
Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded / Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil
❑ Yes El No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: Troy.23.28.20W, Lots 4 & 5,
tea, - CA
l' • ""1~
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD-6710 (R 05191) EZ; ~ Date ;eeoo 'ignature Cert. No.
ADDITIONAL COMMENTS AND SKETCH ,
SANITARY PERMIT NUMBER:
r _ r Safety
~~IILH Bureau
SANITARY PERMIT APPLICATION 201 E. a Wa andshhingtBuildinWater Building gtWater Systems
on Ave.
In accord with ILHR 83.05, Wis. Adm- Code P.O. Box 7969
Madison, WI 53707-7969
! Attach complete plans (to the county copy only) for the system, on paper not less County
than 8112 x 11 inches in size
• See reverse side for instructions for completing this application state Sanitary Permit umber
The information you provide may be used by other government agency programs ❑ Check if revision to previous application
[Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION 0 -12 ry Propert Owner Name
_ Property Location
114 114, S ej T ZJV r N, R Zo E (ortP
Pr perty Owner's Mailing Address Lot Number
Block Number
19
rl 3
Cit St ~ Zip C~ ~7Number ,S~ Subdivision Name or CSM Number 7L
II. TYPE F BUILDING: (check one) ❑ State Owned ❑ city Near st Road
❑ Public 1 or 2 Family Dwelling - No. of bedrooms Z- ❑ Town OF O
111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo v Ya - //$"2. j`
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining
4 ❑ Church/ School 8 _ ❑ Mobile Home Park 12 ❑ Service Station / Car Wash
5 ❑ Hotel /Motel 9 ❑ Office/ Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1. ❑ New 2. 0 Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
. System System Tank Only Existing System_-- Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 410 Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min_/inch) Elevation
VII. TANK Capacity Feef Feet
in gallons Total # of r Prefab. Site Fiber- Ex er.
INFORMATION Gallons Tanks Manufacturers Name Con- Steel Plastic p
New Existin Concrete strutted 91ass App.
Tanks Tanks
Septic Tank or Holding Tank 0-,Pv Z "A.9- El El 0 1:11:1 E]
Lift Pump Tank /Siphon Chamber - rn 1:1 El ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of a onsite sewage system shown on the attached plans.
Plu tier's Name: (Pant) Plu er's SiqDAtw r-(No 5 Trips)
+AP4MPRSW No.: Business Phone Number:
O
7KO- 3,
lu is Address (Street, Ci , State ip C de):
Gtt~ D 1
I . COUNTY / EP RTMENT USE ONLY
l ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue suing Age Sig ture (N a
~'A d Surcharge Fee)
QQQ Pprove ❑ Owner Given Initial
Adverse Determination
a~p~
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety 8 Buildings Divrion, Owner, Plumber
i
I
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin;'Safety and Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the (ounty. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
(ank(s) or other treatment tanks; building sewers; wells; water mains/water service, streams ar d lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location f the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve, pump model and pump manufacturer; D) cross section
of the soil absorption system if required by the county: E) soil test data ona 1 15 form; and F) ad sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a'number of regulated practices which"can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
ti
V iv.onsln Department of Industry, SOIL AND SITE E V A L U AILQhI_R E PORT Page of 3
Lab& and Human Relations
Division of Safety & Buildings in accord with ILHR 8 Ila.
® COUNTY
C3 Ix
Attach complete site plan on paper not less than 81/2 x 11 inches s ` . Plan mu a 1a b ST: ~1_0
not limited to vertical and horizontal reference point (BM), directio % of p PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest r it@. ' C z ~!O - SZ - 5 Q
' REVIEWED BY DATE
APPLICANT INFORMATION-PLEASE PRINT ALL INFO T~QN
PROPERTY OWNER: _ L TIO
d E ( W
T~`~4 Y1 PtS ~31h~~~1Z P~1~R L.CI A IC~C O ` GOV`T` OT I ~1~4 - 114,S Z3 T Z8 N ,R
PROPERTY OWNER':S MAILING ADDRESS VILLA
KOC UBD. NAME OR CSM #
H zp 9 1~1 bw~ lj Du 6 S t D N D sY• f:.~ m~ th c.N
CITY, STATE ZIP CODE PHONE NUMBER GE 5r OWN NEAREST ROAD
t1D L tv N ►'•'t NJ SS Ll [6 (6I z) C1 Z6 - 29 l'7 'j-~ C ova RA fk•D
pQ New Construction Use [X[ Residential / Number of bedrooms Z [ J Addition to existing building
[ J Replacement [ J Public or commercial describe
Code derived daily flow 3O0 gpd Recommended design loading rate - bed, gpd/ft2 - trench, gpd/ft2
Absorption area required _ - bed, ft2 _ trench, ft2 Maximum design loading rate ` bed, gpditt _ trench, gpd/it2
Recommended infiltration surface elevation(s) N -'R . It (as referred to site plan benchmark)
Additional design / site considerations \ IAJ G TPttu V,-
Parent material ao rw, \.'T~ Flood plain elevation, if applicable 618f f It
S = Suitable for system CONVENTIONAL MOUND FIN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U =Unsuitable for s stem 1:3 S LRIU El S ®U ❑ S OU ❑ S O U ❑ S I$I U S ❑ U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouxfary Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rertcft
fi iyivnz>\V i=ii Z- 6-4S -s y CL ~c4
Ground 4 S-V $ 5 lZ- 311
- v S - - - -
elev.
~F eft. y 48 - - S SBR
Depth to
limiting
factor
y.E~
Remarks:
Boring #
3 _
wak ~Z ~ ~,v ►~'1 ~SUII~ \ SSIS T S1
trv M7 cat S lNt t_
n
e-C
nB\ V q-?-" l $Z. taf~v s0 l $3 • EX S
Ground
elev. ft. CIz LS 'l C~- V \S l l.~ T B AJ S
Depth to wV 3o1(- N'UGETt t~S TWS Sl _ IS ~jur
limiting 1 L g S L" -T~ At $ E•
factor
s o►., Q~b~?~C . Dv~ S VTI~. COIV%Ln AJ S S ctt S 04
Remarks: C 2. o'P 3)
CST Name:-Please Print Arthur L. W e e r e r Phone: 715-425-0165
egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022
Signature: Date: CST Number:
M00576
f R e
PROPERTYOWNER~3UVZj~Z.- QIC-ktM1 r SOIL DESCRIPTION REPORT Page J~-of _
PARCEL I.D. # O g O - S l- SO
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Baxxtary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
E )L SLU SC-OP L` 1 t ~~r wti u SYS
o\Z- I-A ~ I Au 5 LLB `nf-t S l C'
Ground ON l L~~llu Irk -n V
.
elev.
ft. Z44SM 1- 'M 5 S C kJ S~ M a
Depth to 1 IU l
L✓l S
V ~kJ ~ R.- 12~ v 'f~
limiting
factor
L.
O
Remarks:
Boring #
4 W.
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
b fit.;
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
PLOT PLAN Page 3 of 3
Sr
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CST Signature Date Signed Telephone No. CST #
s l ~ , L
SAFETY & BUILDINGS DIVISION
Depart Relations
~Qrl'1
April 28, 1995 Washington Avenue
7969
WI 53707
ULBRICHT & ASSOCIATE. law k~--
ROBERT ULBRICHT
655 0' NE I LL ROAD
j~ ~y U t
HUDSON WI 54016 O
RE: PLAN S95-00476 ED: 285.00
BINDER, TOM
LOT 1,23,28,20W
TOWN OF TROY COUNTY OF ST CROIX
HOLDING TANK
PETITION FOR VARIANCE TO CODE SECTION(S):ILHR 83.18 (7)(a)2.
The Department has reviewed the above-referenced submittal.
Conditional approval is hereby granted for the system plan submittal. All
noted items must be corrected. The review and approval of the system is based
on chapter 145., Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin
Administrative Code, and is contingent upon compliance with any stipulations
shown on the plans. This system has not been reviewed for the code
requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin
Administrative Code.
This plan submittal approval will expire two years from the approval date, or
if a sanitary permit is obtained, plan approval will expire on the day the '
initial sanitary permit expires. The licensed plumber responsible for this
installation shall keep one set of plans with the Department's stamp of
approval at the construction site. The installer shall notify the appropriate
inspector when inspections can be made.
All of the statements and supporting documentation included with the petition
were considered. Since your request is similar to other petitions approved by
the Department (e.g.S94-04497), the petition is conditionally approved.
The conditions are:
- A meter, with remote reading device, shall be installed by a properly
licensed plumber, on the water system, that adequately measures the amount
of water used by the structure, excluding hose bibs and wall hydrants,
which do not discharge into the sanitary system.
- Whenever the licensed pumper and/or the marina terminate their contracts, or
refuse to hall or pump the sewage, St. Croix Co. shall be notified
immediately.
ORIGINAL
SBDA 7M (R. 1644)
SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Industry, Labor and Human Relations
ULBRICHT & ASSOCIATES
Page 2
April 28, 1995
PLAN S95-00476
The petition is to allow replacement holding tanks to be installed on the site
with the contents pumped to a holding tank on a barge, transported across the
St.Croix River then transferred to a pbmper truck for disposal.
This petition approval is granted conditionally with the understanding that
all of the petitioner's statements included on the variance application form
and any other documents submitted to the Department will be carried out. This
variance is specific to the subject petition and cannot be used for any
additional modifications.
All permits required by the city, village, township or county shall be
obtained prior to installation.
Inquiries should be directed to me at the number listed below. Please refer
to the plan number shown above.
Sin erely,
ames Quinlan
Plan Reviewer
Section of Private Sewage
(608) 266-3937
8079L/ 2
cc: ST CROIX
Leroy G. Jansky
Department of Natural Resources
$ROA-7M I R. 101W 1 1
I.1h'J1'11VJN r utc. v ~c 1v ,,lyr~x x~l1
' Wisconsin Department of Industry, Labor and Human Relations OFFICE USE ONLY
OFFICE USE NLY Safety and Buildings Division Petition No.
Amount paid 201 East Washington Avenue, P.O. Box 7969
Madison, Wisconsin 53707 E-Number
i p t No • 608/266-3151
Name of Owner/Petitioner Building or Project Agent, Architect or Engineering Firm
-r- pM S /,✓DE,( SE~}Sa•✓~L crf 134 7YI-13,P/ GAT SSbG/ TES
Company ,Tenant Name, if any Street & Number
O k/.v 'EFR [OS ~5- 0 " va-~L-
Street & Number Location, Street & Number City State, Zip Code
2- `Ar ~'s ff vnso~ w~• SYo~
City State Zip Code City County Telephone Number
Eoi;vq- ,~i,v. ~r✓DSo.✓ - 54. ~~'X 3 P6'
Telephone Number Plan Number, if known Name of Contact Person
2- 7 Rc13EQ-F -2JL-13RiC1-T'
1. The rule being petitioned reads as follows: (cite specific rule number and language) 23. (7) <Gt-) Z .
ell
f~oGO/~ TA,y~S 7 SE~t'fi/ PO~PT o~E' ~ilN~1 d/E' Go(' of ,q~
hpGDi~(r sGA// /oc TEO No ~D,PE' A-., z5"'~~Pvr! s~'~~'
1/lam" o .P
2. The rule being petitioned cannot be entirely satisfied because: ~YtE' ~X~ST/N~s ciJ~r~ T~N~S~ ~Z->
/IXW ,VO7- S6-;F0E2 IFy
~Reo~~ Ty -t f'o•y 13 f r /3 o/f 7--
VA/ ~DERT)!~ y
S~~EP ~ vE,v) s /JNV /%Grf~ED ofd - piPo/s~~%~s acv v ~a A/
The following alternative(s) and supporting information are proposed as a means of providing an equivalent degree
~ealth, safety or welfare as addressed by the rule:
~R6/d O s 6"V /TD/~%~ (r 7/J.yi~S Gull
s~ C~QpiX iP/vii ] /~y ,q- //CE>ysEy ~yypEh' Div 7'1oj eviW-t A
/A1;44 'S I34 e6:f Bo>4 i ~Q0 1 "E=D cy'k AA~i01F SLEW A6-tE". ~urDS i 4A ASKS.
6.6 0 i k A C T' - /4h T T,QCAk r,> 1 LU 1 PA OS -f Qn.A'.0 ~
SSW
aUMQ "Te0LK oA-' D 0SIJE 5~Ok~ -'0k- iOAL L-e<A~L 0I'sPdS-4L
ham- CviS ~fl S SuCt A- - oG6 o paR^TI'O,~3
f},a c o P Pe, Dit-4 s o P f f i D>, tjC-fi 5-oleo,-~ o w~ER o ~a E !l
'F12,4S~121 >ni►~tS 6U-V- '1w Ag- S No cvhtEl2 SOU iCE >gUf~f1~4131L~
40 `AtJ'S SEASoX-~AL- c^PNia iN bOihnTf -K wkGO ")EP- MAY k EZ
Note: Please attach any pictures., plans, sketches or required position statements.
VERIFICATION BY OWNER - PETITION IS VALID ONLY IF NOTARIZED AND ACCOMPANIED BY REVIEW FEE
See Section Ind 69.15 for complete fee information
Note: Petitioner must be the owner of the building or project. Tenants, agents, designers, contractors, attorneys,
etc. may not sign petition unless a Power of Attorney is submitted with the Petition for Variance Application.
KA- A, S of , being duly sworn, I state as petitioner that I have read the foregoing
~f 10
(NAME OF PETITIONER, Please type print)
petition, t believe 't t e true and I have significant ownership rights in the subject building or proojecctt.
Subscribed and sworn to before me this date: Signature tioner
r ■
My commission expires: LOUIS - INNES07A
SE B QWM
1
ILI -vv""w
Notary Pu is
1 -0 HENNEPINCOUNTY
SB-8 (R .09/80) evw+r My Comm. Expires Jan. 31 2000
ULBRICHT & ASSOCIATES CO.
655 O'Neil Road • Hudson, WI 54016 Reg. Designers of Engineering Systems
715-386-8185 Private Sewage Consultants
PROJECT INDEX
DILNR Plan I.D. # S95-00476 Date _April 2Rfla95
Owner Tom & Patricia Binder Phone 612-926-2917
Address 4209 Morningside Road Edina, Minn. 55416
Legal Description---
Parcel # 040-1152-50. Part of Gov. Lot 1, lots 4&5.
Sec. 23, T28N,R20W.
Town of Trod-- County _St_- CraiX C.S.T. Installer
Arthur L. Wegerer CSTM00576
Local Authority/ Supervision
St. Croix County Zoning Dept.
PROJECT DESCRIPTION The owners seasonal 2 bedroom cabin was
completely destroyed by fire (1994).
Soil and site verifications indicate the existing system (sited
in dolomite) can not be reused, and that no other type of
treatment system is possible. This has been verified by Ulbricht
& Associates, who even considered variances using aerobic
treaTment systems, rockless trencres,etc.
Unique site problems: it is legally land-locked from any
type of service road. Access to cabin is by boat from the St.
Croix River beach. No excavating equipment, mound sand, or
sewer aggregate can be practically brought up the bluff (federally
protected National Scenic Riverway). There is no access by any
rpad, nor are any neighbors willing to grant permission to cross
their property.
The cnly conceivable solution - retain the existing code
compliant leak free steel septic tank (inspected by designer)
and convert it, per conditions specified in plans, into a rclding
tank. A 2nd steel tank will be slide into the deep drywell cavity.
Drywell is dry.
The project will need a petition for variance modification
in regard to pumping service. The licensed pumper (see contracts)
will need to use a marina barge to pump the tanks from the
shoreline, and pump from a distance cf 150-200 feet. With very
limited seasonal, ocassional occupation, and with all new water
saving fixtures, pumping needs will be very minimumal.
(PROJECT INDEX CONTINUED)
r- ~L!
a C 01Y l
Pg .1 PLOT PLAN VIEWS 4; s' +6
Pg.2 HOLDING TANK CROSS SECTIONS & SPECS
MWIL
UL
miss
NMK
~~nrnonm►+~
ULBRICHT & ASSOCIATES CO.
655 O'Neil Road - Hudson, WI 54016 Reg. Designers of Engineering Systems
715-386-8185 Private Sewage Consultants
REQUIREMENTS & CONDITIONS
1. New replacement cabin shall be fitted with a water meter,
complete with remote display for inspection monitoring
purposes.
2. Existing exterior c/o (4" c.i.) located 40" upstream of
the existing steel septic tank, can be retained if provided
with a code compliant frost proof sleeve.
3. Existing 1000 gal steel septic tank, to be re-used as a.
bolding tank, shall have additional 24" steel manhole risers
(watertight) extended to 4" above finished grade, and provided
with code compliant lock cover. New cover shall have proper
label & code compliant 4' vent (tank is currently ventless).
4. High water alarm shall be mounted inside cabin.
i
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Wisconsin Department Industry,
Labor and Human Relations HOL ING TANK AGREEMENT safety and Buildings Division
V01-111 - 81`a ~E 563 Bureau of Buildings and Water Systems
Document No. / Plan Identification No.
This This agreement is made between the This t ace reserved for recording data
c 5 governmental unit and holding tank IS
.Agreement to owner(s) 1irS OFFICE
A /j ST. cROtX Co.,
s
County or L cal Gov rnmental unit Ret:~dforR~,rd
Holding Tank Owner(s)
N ,3,.,lJ~;e APR 2 4. 1995
called Municipality be/ow)
We acknowledge that application is being made for;the installation of (a) holding at 12:30 p
tank(s) on the following property: (Provide legal land description) '
Regfaterof Deeds
j 57" vJ
Rio,
Return To
`a - -
orthat contin ued use of the existing premises requires that a holding tank be installed on the pr operty for the purpose of proper / containment 'r of 'e sewage~
Code, or Ch. 145, Stats.
Also, the property cannot now be served by a municipal sewer, or any other type of private sewage system as permitted under Ch. ILHR 83, Wis. Adm.
.
As an inducement to the County of
to issue a sanitary permit for the above described property, we agree to do the following:
1. Owner agrees to conform to all applicable requirements of Ch. ILHR 83, Wis. Adm. Code relating to holding tanks. If the owner fails to have the
holding tank properly serviced in response to orders issued by the municipality to prevent or abate a human health hazard as described in s. 254.59,
Stats., the municipality may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing
the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.60, Stat r .
2. The owner agrees, pursuant to s. ILHR 83.18 (10), Wis. Adm. Code, to have installed in a new building or new structure a water meter approved b
the County and State. The water meter shall be installed by a plumber authorized by the State to conductssuch installations, with said installation
with State regulations and manufacturers specifications. The owner agrees to be financially responsible for the y
maintenance, and repair of the water meter, and agrees to allow the municipality to enter the above described property on a regular basis tore'ad
and/or inspect the water meter. purchase, installation,
3. Owner agrees to pay all charges and cost incurred by the municipality for inspection, pumping, hauling, or otherwise servicing and maintaining the
holding tank in such a manner as to prevent or abate any human health hazard caused by the holding tank. The municipality shall notify the owner
of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within
thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of
a human health hazard, and the tax shall be collected as provided by law.
4. The owner, except as provided by s. 146.20 (3) (d), Stats., agrees to contract with a person who is licensed under Ch. NR 113, Wis. Adm. Code, to have
the holding tank serviced and to file a copy of the contract or the owner's registration with the municipality. The owner further agrees to file a cop
of any changes to the service contract, or a copy of a new service contract, with the municipality within ten (10) business days from the date of
change to tfie service contract. y
5. The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code, who shall submit to the municipality on a semiannual basis a
report in accordance with s. ILHR 83.18 (4) (a) 2., Wis. Adm. Code, for the servicing of the holding tank. In the case of registration under s. 146.20 (3)
(d), Stats., the owner shall submit the report to the municipality. The municipality may enter upon the property to investigate the condition of the
holding tank when pumping reports and meter readings may indicate that the holding tank is not being properly maintained.
6. This agreement will remain in effect only until the local governmental unit responsible for the regulation of private sewage systems property is served by either a municipal
sewer or a soil absorption system that complies with Ch. ILHR 83, Wis. Adm. Code. In addition, this
agreement may be cancelled by executing and recording said certification with reference to this agreement in such mannerwhich will permit the
existence of the certification to be determined by reference to the property.
7. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit the agreement to the
register of deeds, and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of the agreement to be
determined by reference to the property where the holding tank is installed.
Owner(s) Name(s) - Prin
G Notrize Signature
Subscribed'and sworn to before me on this date:
,
/-2 9 9 Sl
Murncipal Official Name -Print
Municipal Offical Signature
b e tt h A t_ 03 m CL T-
Municipal Official Title - Print / C~~'R a~rH~ffu nres~~Cl ~Q
F ~IC.v.
GV,p 1 R pk: f2 so 1111
The information you provide maybe used by other government agency programs (Privacy Law, s. 15.04 (1)(m)l
SBD-6113 (R. 04/94)
5224G S HOLDING TANK SERVICING CONTRACT
:on;raclDate VOL1099PAPF143 w,r1e"}y OM4 1~/53a
/ O - I I _ Gy This contract is made between the
/ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
lotding Tank Owner(s) Name(s) and ( Pumper's Name
A o N , jc>1/pso V s A/ , FIP-7 ~ w
7 was Qty r I
Ve acknowledge the Installation of (a) holding tank(s) on the following property: (Provide legal description:)
6,64 f + S 4 /3a,r- GvfS e/ f- St Croix & -pe A
5010 013 7a ~ N R ,9
Y Cor Lod- y /V t 4-Y o N~ Coo
Lot N 01 S- ° W -,fo 04 ke,.' w i y A ►g GA
~
?k 40 PD A- - ° f
l. The owner agrees to file a copy orlhis contract with the local governmental unit hereinafter called the "municipality", which has
signed the pumping agreement required in Ch. ILHR 83.18 (4) (b), Wis. Adm. Code and
with the County of Oro j >e, WIT.
The owner agrees to have the holding tank(s) serviced by the pumper and guarantees 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 maintain the all-weather access
road or drive so that the pumper can service the holding lank(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.
The pumper agrees to submit to the municipality which has signed the pumping agreement required by s. ILHR 83.18 (4) (b), Wis.
Adm. Code, 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; ;51. GROix Go, ~3la'i
b. The name of the owner of the holding tank; Rmc'd for Facord
C. The location of the property on which the holding tank is installed; ~l
d. The sanitary permit member issued for the holding tank: OCT 13 1994
e. The dates on which the holding tank was serviced; 10:30 J A. Nil
f, The volumes in gallons of the contents pumped from the holding tank for each servicing; g'
g. The-disposal sites to which the contents from the holding tank were delivered.
111 ~ ~
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 the municipality
and the County named above within ten (10) business days from the date of change to this service contract.
9
Dwneer(s) Name(s) (Print) I Owner's Sirlnal (s)
ITGt o•Ma, S 4Y 16 nC~~
1 MgStC~ ~J I Subscribed and sworn to before me on this date:
4'ob°
MPIS r IUD I J
Pumper's Name (Print) ( Pumlier•s Signature otar ubh
i H I S M r, ytyt e
,
0.000
C~ yL~ 7 , 1v,0 N I My commission expires:rsV y,x ~J
Pumper's Registration Number .
e5;o, 0 06j
SBD•7574 (N. 11185) This instrument was dratted by the Stale of Wisconsin Departmenty4.~'' ~.0
Sir
of industry, labor and Human Relations, Bureau of Plumbing. `1 A
. f
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER(f~l r sP/!
MAILING ADDRESS .zO x C r
PROPERTY ADDRESS .2
(location of sep c system) Please obtain from the Planning Dept.
CITY/STATE- 1
~W49 #11 41 yes
PROPERTY LOCATION 1/4, 1/4, Section T_~N-RAW
TOWN OF ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER yA:5_
CERTIFIED SURVEY MAP , VOLUME- , PAGE , LOT NUMBER
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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost
of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that owners of all new systems agree to
keep their system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)
the on-site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
I/We, the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year expiratio
SIGNED: ~7
DATE: / a2
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
S T C - 100
This application form is to be completed in full and signed by the
owner(s) of the property being developed. Any inadequacies will
only result in delays of the permit issuance. Should this
development be intended for resale by owner/ contractor, (spec
house), then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
Gv~~l oNpi sY
Y
Location of property 1/4 1/4, Section T_,aL_N-R,-.!t0 W
Township d ! Mailing address yr~f ~f< r
Address of site
subdivision name CroF~r CJ-1 Lot no.
Other homes on property? Yes No
Previous owner of property
r
Total size of property
Total size of parcels
Date parcel was created
Are all corners and lot lines identifiable? ✓ Yes No
Is this property being developed for (spec house)? Yes 1✓ No
Volume /O and Page Number j3 L as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. S~3 .5'ya, , and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office of the County Register of Deeds as Document No.
5-/ 3 Irya
S Ap icant Co-Applicant
7 /-5 Ac?, ~ -
Date of ignature Date of Signature
DOCUMENT NO.
WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA
'
~I13a„~~o I S_iE BAR OF WISCONSIN FORM 2-1982-,
I~
VIA, 532 ~i
Doris Elaine Finn, a/k/a Doris E. Finn I ST. CRCIX CO., ~+y(
f^ce' d f,- r !c:': _1
^c'
FE B 2 8 1994
. .
y... y.............
spnveyy and wnrrnnts to ThOmaS N. Blrider and Patricia A. P a 3:SQyt M
, ..husband and
wif_ e_ as ..Joint_.tenants with
ri t of s
urviwrship Rvstercroseft
-
7GW1'~to&-Werthei
1430 Second St. P. O. Box 106
. _
St...
r..
the following described real estate in ~~O. Hudson, YVI 54016
State of Wisconsin: -T- -
Tax Parcel No 040 73-15,X-50.........
Lots four (4) and five (5), St. Croix Brach, in the Town of Troy, subject to and together
with the rights of the casernent recorded in Volume 463, page 23, Register of Deeds office for
St. Croix County, and herchy quit clairlls to said grantee (lie following land adjacent to said
lots:
Beginning at the Northwesterly corner of Lot 4, Plat of St. 'roix Beach, Town of 't'roy;
thence Northeasterly 100 feet to the Northeasterly corner of l..ot 5 of said Plat of St. Croix
Beach, thence N25°10'\\' to Lake St. Croix; (hence \Vcstcrly alum; the shore line of said Lake
St, Croix to a point N25°10'\V of the paint of' beginning; (hence to point of beginning.
III
This 1SI70
homestead property.
(iw (is not)
Exception to warranties: T x PH WITH AND SUB EC.r TO any other easements, covenants,
reservations or restrictions of record, if anv, but this shall not be deemed to extend any
such other recorded encumbrances beyond the team established by law therefor.
Dated this Z5 ti........ Febru
day of ......................Zrv..........................
19...94..
Doris Elaine F (SEAL)
,
(SEAL) ........(SEAL)
I
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Doris Elaine Finn , a/k/a STATE OF WISCONSIN
Dori E Finn Ss.
Y County.
authen'! ted is Z Y of - Febz'.'aL.r 19..... 94
"""""`y' Personally came before me this ................day of
19 the above named
Hu H. gain
TITLE: MEMBER STATE 13AR OF WISCONSIN r'
(fnot,
authorized b
~
Y § 706.06, yVis.•Stats.) .
to me known to be the person who executed the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
' Atty. Hugh H. Gain ~
430 2nd St., Hudson, WI 54016
Notary Public
(Signatures may be authenticated or acknowled6ged. Both. My Commission is permanent stCottr~ ty, Wis.
are not necessary.) . (If not, state e~tpiration
date : 19. . )
'Names of persona siznin$ in any capacity should betyped or printed below their sl¢nntures.
WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc.
VoIIM No. 2 IV82 Milwaukee, Wisconsin