HomeMy WebLinkAbout002-1056-80-025 PRIVATE SEWAGE SYSTEM County: St Croix
Wisconsin Department of Commerce
Safety�c Building Division
INSPECTION REPORT Sanitary Permit No:
515087 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:
Bazille, Tim Baldwin, Town of 002 - 1056 -80 -025
CST BM Elev: Insp. BM Elev: r escription: Section/Town /Range /Map No:
/ on CST 23.29.16.350A10
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
3. 163. K 7 ab
Dosing Alt. BM
Aeration Bldg. Sewer 94 -
4. 4
Holding St/Ht Inlet 7. 77 9
St/Ht Outlet
TANK SETBACK INFORMATION
TANK TO P /L' WELL BLDG. Vent to Air Intake ROAD Dt Inlet
feptfc /315 ! Q � s Dt Bottom
Dosing Header /Man.
Aeration Dist. Pipe
Holding Bot. System
Final Grade
PUMP /SIPHON INFORMATION
Manufacturer Demand St Cover yC
GPM
Model Number
TDH Lift Friction Loss System Head H Ft
Forcemain Length Dist. to Well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM T P/L LL - LAKE /STREAM LEACHING Manufacturer:
INFORMATION Q , CHAMBER OR
Type Of System: A 1 UNIT Model Number:
DISTRIBUTION SYSTEM �(�
Header /Manifold Distribution x Hole Size x Hole Spacing Ve to A ir Intl e
Pipe(s)
.a� �e.
Length Dia Length Dia pacing
SOIL COVER x Pressu a Systems Only xx Mound Or At - Grade Sys s Only
Depth Over, Depth Over xx �Deptl Seeded /Sodded xx Mulched
D er Center Bed/Trench Edges
"�,1 Yes � No �es [ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: O / / Inspection #2: / /
Location: 2558 80th Ave Woodville, WI 54028 (SW 1/4 SE 1/4 23 T29N R16W) NA Lot C Parcel No: 23.29.16.350A10
1.) Alt BM Description = ®��►l
2.) Bldg sewer length = /�O T , �,• J �.a , v 2-5 6
- amount of cover = / p� JL �OJ SQ
Z• CoJQ•. LJ � � �� �
Plan revision Required? Yes [!] No
Use other side for additional information.
Date Insepctor's Signature Cert. Nr
SBD -6710 (R.3/97)
Wisconsin, Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety anC Building Division
INSPECTION REPORT Sanitary Permit No:
515087 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:
Bazille, Tim I Baldwin, Town of 002 - 1056 -80 -025
CST BM Elev: Insp. BM Elev: BM Description: Sectionlrown /Range /Map No:
23.29.16.350A10
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing Alt. BM
Aeration Bldg. Sewer
Holding St/Ht Inlet
St/Ht Outlet
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Dt Bottom
Dosing Header /Man.
Aeration Dist. Pipe
Holding Bot. System
Final Grade
PUMP /SIPHON INFORMATION
Manufacturer Demand St Cover
GPM
Model Number
TDH Lift Friction Loss System Head TDH Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of System: UNIT Model Number:
DISTRIBUTION SYSTEM
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
Pipe(s)
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 [E No [] Yes 0 No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / /
Location: 2558 80th Ave Woodville, WI 54028 (SW 1/4 SE 1/4 23 T29N R16W) NA Lot Parcel No: 23.29.16.350A10
1.) Alt BM Description =
2.) Bldg sewer length =
- amount of cover =
Plan revision Required? 5 Yes F] No
Use other side for additional information.
Date Insepctor's Signature Cart. No.
SBD -6710 (R.3/97)
Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162 St. Croix
r►seonsin Madison, WI 53707-7162 Sanitary Permit Number (to be fitted in by Co.)
Department of Commerce (608) 266 -3151 G / G Qei
State Sanitary Permit App 'c State Plan / I�A / .�N - umber
In accord with Comm 83.21, Wis. Adm. Code, personal informati u ]
may be used for secondary purposes Privacy Law, s 15.04 ) Project Address (if different than mailing address)
I. Application Informati a Print All Information 55 re o4i
4 2
% , Ae—
Property Owner's Name I Parcel # Lot # Bloek #
Tim Bazille VO JUN 2 22009 ZZ. / • bZ
Property Owner's Mailing Address Property Location
2558 80` Ave. ST CROIX COUNTY
City, State Zip Code "W SW ' /a, SE %, Section 23 e ,
Woodville, WI 54028 715/698 -2328
T 29 N; R 16 W
H. Type of Building (check all that apply)
X 1 or 2 Family Dwelling - Number of Bedrooms Three 1MG Subdivision Name CSM Number
_Public/Commercial - Describe Use
_State Owned - Describe Use ❑City_ ❑Village XTownship of
Z 56c) t Baldwin
5 �
III. Type of Permit: (Check only one box on line A. Complete line B if a plicable)
A. New System X Replacement System
❑ Treatment/Holding Tank Replacement Only 11 Other Modification to Existing System
B. [I permit Renewal ❑ Permit Revision Change of 11 Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Owner Owner
IV. Type of POWTS System: Check all that appl
Non - Pressurized In- Ground Mound ? 24 in. of suitable soil Mound < 24 in. of suitable soil At -Grade ❑ Single Pass Sand Filter
❑ Constructed Wetland ❑ Pressurized In- Ground X Holding Tank Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter
❑ Recirculating Synthetic Media Filter ❑ Leaching Chain er np me ❑ Gravel -less Pipe ❑ Other (explain)
V. Dispersal/Treatment Area Information:
Design Flow (gpdX Design Soil Application Rate(gpdsf) Dispersal Area Required (st) Dispersal Area Proposed (sf) System Elevation
450
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank 2500 2500 1 Wieser Concrete X
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWT'S shown on the attached plans.
Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number
Jack A. Bowman v ??2839 715/418 -1349
Plumber's Address (Street, City, State, Z' e)
13437 409" St., Ridgeland, WI 54763
VIEL. County/Department Use Onl
Approved ❑ Sanitary Permit Fee (includes Groundwater D Issu Issuin ent Sign o S
Reason for Den Surcharge Fee) 60 06 / 29 dl
IX. Conditions of Approval/Reasons for Disapproval `_► / I �1
1 ) Al 5t,+ rG� ✓.YG rKG� -'rJ M v64 � Y�b. %t 6 �^ q O
're 60 Vo keLLc 2j Geier ,ryO";M v
ttnch complete ans (to the my only) for the system on paper not less & 81 11 inches in sine
3) 0 �t� , rA d &e ,n o r t �
Go. -. k� p Aet-cj k ou sA- .
HOLDING TANK SITE PLAN
Project: BAZILLE
N Legal Description: SW,SE,S23,T29N /R16W
Subdivision Name: N.A.
Scale: 1: 0_ Parcel ID: 002 - 1056 -80 -025 Lot No.: N.A.
`�' � • 1.
l2cmvvc� �
40' 4'" cc%, Q
4
a 3n1 �{ Elev. 93,
J
O r
=x
'e
Q �t
i
G�
Transaction I.D.: Page 3 of 8
I S
CONCRETE HOLDING TANK DESIGN
Single Tank Option
INDEX AND TITLE SHEET
Project BAZILLE
Owner Tim Bazille
Address 2558 80th Ave.
Woodville, WI 54028
Legal Description SW,SE,S23,T29N /R16W
Township Baldwin County St. Croix
Subdivision Name N.A. Lot No. N.A.
Parcel ID Number 002 - 1056 -80 -025
Plan Transaction ID Number
Index and title sheet Page 1
Holding tank specifications Page 2
Site plan Page 3
Maintenance and contingency plan Page 4
Holding agreement Page 5
Pumping contract Page 6
Tank specifications Page 7
Attachment: soil test Page 8
Designer loretta / Jack Bowm
Signature rn - -- '` Phone No. 715/418 -1349
Licens mber MP222839 Date 06/08/09
Designed pursuant to:
Holding Tank Component Manual For POWTS
SBD- 10571 -P (R.6/99)
Version 2.0 (03/01) Pagel of 8
HOLDING TANK SPECIFICATIONS
3 Number of bedrooms
Non - residential estimated flow (gpd)
2000.0 Minimum holding tank volume required (gal)
2500.0 JProposed holding tank capacity ( al)
Weiser Concrete Tank Manufacturer
W2500 -MR Tank model number
S. J. Electra Alarm manufacturer
S.-J1 JAlarm model number
Tank Dimensions and Data Tank Anchor Calculations
X for rotind tank 7 , fdrj- Ibs Weight of tank and cover
51.0 Liquid depth below inlet invert (in) , p Safety factor
8.0 Maximum de th of soil cover (ft) Z4 I I , ibs Weight of anchor required
71.0 Height (in) Outside in Soil cover req. for anchor or
159.0 Length (in) Dimensions yd' Concrete counter weight
93.0 Width (in) Only
HOLDING TANK CROSS SECTION
manhole cover with
locking device and finished vent cap
junction � warning label grade
12" min.
box
24 in. a I
Manhole and vent locations :tvent pipe "
conduit may be reversed. 1s min•
building sewer
-- - service � 12.0 in - - - - -- inlet
blind plug alarm on Note: All tank joints, and
to seal joints between tank
outlet openings and piping are
Electrical as per 39.0 in. sealed watertight. All pipe
NEC 300 and vent materials comply
and Comm 16 with Comm 84.
3 in. bedding under tank. Tank is anchored as necessary to negate buoyancy.
Project: BAZILLE
Transaction N umber: Page 2 of 8
HOLDING TANK MANAGEMENT PLAN
This Private Onsite Wastewater Treatment System ( POWTS) has been designed, and is to be installed and
maintained according to Comm 83, Wis. Admin. Code, the Holding Tank Component Manual (SBD- 10571 -P
6/11/1999), and the St. Croix County Sanitary Ordinance.
1. This POWTS is designed to accommodate an estimated domestic wastewater flow of 500.0 gpd.
2. The owner of this POWTS is responsible for system operation and maintenance, including all provisions in
the attached Holding Tank Servicing Contract and Maintenance Agreements.
3. Each time the wastewater in the tank reaches 90% of the tank(s) capacity or a level of 12" below the inlet
(at which time the alarm will activate), the pumper listed in the current Servicing Contract must be called to
empty the tank's contents and dispose of them in accordance with NR 113, Wis. Adm. Code.
4. At each service event, the service provider should visually inspect the condition of the tank, risers and
manhole cover(s) and verify that the alarm system functions and manhole locking devices are present.
Discrepancies are reported to the owner in a timely manner for corrective action. All corrective actions
shall comply with the county sanitary ordinance and Comm 83 and 84 Wis. Adm. Code.
5. All service events or inspections of this POWTS shall be reported to the county within 10 business days.
6. The owner may not remove any of the wastes from the holding tank(s), or cause such wastes to be
removed by any person not authorized to do so under Ch. 281, Wis. Statutes. The discharge of wastes
tank to the ground surface, including intentional discharges and discharges caused by neglect, constitutes
a failing POWTS and may result in issuance of correction orders or a citation by the county or state.
7. No one should enter a holding tank for any reason without being in full compliance with OSHA standards
for entering a confined space. The atmosphere within these tanks may contain lethal gases, and rescue
of a person from the interior of the tank may be difficult or impossible.
8. In the event that this POWTS fails and cannot be repaired, a code compliant replacement holding tank
may be installed in the same location (a new sanitary permit is required for such a replacement). Con-
nection to municipal services would also be considered at this time if they are deemed available to the
property.
9. if this POWTS is replacer!, or its use discontinued, components no longer in use it shall be abandoned in
accordance with Comm 83.33 Wis. Adm. Code.
10. If there is a problem with, or question about this installation, the following persons should be contacted:
a. Installer ............................. J.B. Hydro Phone: 715/418 -1349
b. Service Provider .................. J.B. Hydro Phone: 715/418 -1349
c. Co. Zoning or Health Dept. St. Croix Zoning Phone: 715/386 -4680
11.
Project: BAZILLE
Page 4 of 8
Transaction Number:
• ! Illfll 111!111!1! !111! IIIII illfl IIII llllli Ifll 1111
HOLDING TANK AGREEMENT * 8 9 8 5 9 9 1
This agreement is made between the governmental unit and holding tank owner(s) 898599
Governmental Unit 6EW PABST
Agreement Date Baldwin REGISTER OF DEEDS
� — �� � a `1
Holding Tank Owner(s) Plan Transaction Number ST. CROIK CO., WI
RECEIVED FOR RECORD
Tim B a z i l l e 06/22/2009 02 : 45PM
We acknowledge that application is being made for the installation of (a) holding tank(s) HOLDING TANK AGREEMENT
on the foltovAng described property (Provide legal description) : EXEMPT a
REC FEE: 11.00
C 2558 80th Ave., Baldwin township PAGES: 1
St. Croix county 11
p+- SWk,SEk,S23,T29N /R16W DO NOT W RITE IN THIS SPACE �5
(c5 AL4-- I h A4r— (Oq I k. 13 Parcel Number
Boa �05�o- ?o -Oas.
�}u ro. T� B�z� tl�
As an inducement to the county to issue a sanitary permit for the above described property, we agree to do the following: a s Sk qtr. fqut—
c�sodvillC Wr
1 . Owner agrees to conform to all applicable requirements of Ch. Comm 83, Wis. Adm. Code relating to holding tanks. If the owner fails SVOag
to have the holding tank properly serviced in response to orders issued by the governmental unit or the Department of Commerce to
prevent or abate a human health hazard as described in s. 254.59, Stats., the governmental unit 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, Stab.
2. The owner agrees, pursuant to s. Comm 83.54 (2), and Comm 82.40(3)(e), Wis, Adm. Code, to have a water meter Installed in the
structure. The water meter shall be installed by a plumber authorized by the Department of Commerce to make such installations.
with said installation complying with State regulations and manufacturers specifications. The owner agrees to be financially
responsible for the purchase, installation, maintenance, and repair of the water meter, and agrees to allow the governmental unit or
the Department of Commerce to enter the above described property on a regular basis to read and/or inspect the water meter.
3. Owner agrees to pay all charges and costs incurred by the governmental unit or county 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 governmental unit shag 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
char 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, agrees to contract with a person who is licensed under Ch. NR 113, Wis, Adm. Code, to have the holding tank serviced
and to fie a copy of the contract with the governmental unit. The owner further agrees to file a copy of any changes to the service
contract, or a copy of a new service contrail, with the governmental unit within ten (10) business days from the date of change to the
service contract.
5. The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code, who shall submit to the county on a
semiannual basis a report detailing the servicing of the holding tank. The governmental unit or county 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
property maintained.
6. This agreement well remain In effect only urrtM the county office responsible for the regulation of private onsits wastewater treatment
syste: is certifies that the property is served by either a municipal sewer or a private onslte wastewater treatment system that
complies with Ch. Comm 83, Wis. Adm. Code. In addition, this agreement may be cancelled by executing and recording said
certification with reference to this agreement in such manner which 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 shag submit this
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) - Please Print Subscribed and swom to before me on this date: ;Y .••'' ••.�>
Tim $azille 5:-01q -0 .Z�' '4� •Les
c . r.
Notarized Owner's Signatures) Notary Public
Governmental Unit I are, Tale - Please Print My Commission Expires O�
Ail
•• t'A Q
m ne t nit ci na r Drafted by:
O f
loretta — LanLperctesting
PersU infomnation you provide may be used for secondary purposes (Privacy Law s. 1 .04(i)(m)1
1 of 1
HOLDING TANK AGREEMENT
This agreement is made between the governmental unit and holding tank owner(s)
Agreement Date Governmental Unit
0 a Baldwin
Holding Tank Owner(s) Plan Transaction Number
Tim Bazille
We acknowledge that application is being made for the installation of (a) holding tank(s)
on the following described property (Provide legal description) :
C 2558 80th Ave., Baldwin township
St. Croix county
SW 4 , S E q , S 2 3 , T 2 9 N/R 16W DO NOT WRITE IN THIS SPACE
Parcel Number
ooa - iO S640-0as-
As an inducement to the county 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. Comm 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 governmental unit or the Department of Commerce to
prevent or abate a human health hazard as described in s. 254.59, Slats., the governmental unit 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, Slats.
2. The roamer agrees, pursuant to s. Comm 83.54 (2), and Comm 82.40(3xe), Wis. Adm. Code, to have a water meter installed in the
structure. The water meter shall be installed by a plumber authorized by the Department of Commerce to make such Installations,
with said insta
Uation wnifin state
comphrirng regulations and manufadurera specifications. The owner agrees to be financially
responsible for the purchase, installation, maintenance, and repair of the water meter, and agrees to allow the governmental unit or
the Department of Commerce to enter the above described property on a regular basis to read andfor inspect the water motor.
3. Owner agrees to pay all charges and costs incurred by the governmental writ or county 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 governmental unit shall notify the owner of any costs which shah 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, 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 with the govemmental unit The owner further agrees to file a copy of any changes to the service
contract, or a copy of a new service contract, with the governmental unit within ton (10) business days from the date of change to the
service contract.
5. The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code, who shall submit to the county on a
semiannual basis a report detailing the servicing of the holding tank. The governmental unit or county 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
property maintained.
6. This agreement will remain in effect only until the county office responsible for the regulation of private onsite wastewater treatment
syste, is certifies that the property is served by either a municipal sewer or a private onsite wastewater treatment system that
compiles with Ch. Comm 83, Wis. Adm. Code. In addition, this agreement may be cancelled by executing and recording said
certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by
reference to the property.
7. This agreement shah be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit this
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) - Please Print Subscribed and sworn to before me on this date:
Tim Bazille 0�� --��
Notarized Owner's Signature(s) Notary Public
Governmental Unit i ape, Title - Please Print. My Commission Expires
309ve m-flaqwl U nit offi 19n Drafted by:
loretta — LanLperctesting
Pe a 'reformation you provide may be used for secondary purposes fPrivacv Law s. 15.040 Nm)l
HOLDING TANK SERVICING CONTRACT
Contract Date
5 - 3i --oq
Th is contract is made between the
Holding Tank Owner(s) Name(s) — — — — — — — — — —
and Pum r --- - - - - --
t pe sName — — — — — — — — — — — — — — — —
. 1
Mr. Tim Bazille i - DO-t' re
We acknowledge the installation of (a) holding tanks) on the following property: g P P rty: (Provide legal descriptions:)
58 80th Ave. Baldwin townshilo, St. Croix county
S W4 , SE4 , S 2 3,T29N /R16W
1. The owner agrees to file a copy of this contract with the local governmental unit that has signed the um
required in Ch. ILHR 83.18(4) (b), Wis. Adm. Code and with the County of St. Croix P ping agreement
2. The owner agrees to have the
holding anks g ( service
to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees �t t maintain the access a ccess and pumper to have
drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay he
Pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper.
3. The pumper agrees to submit to the local governmental unit which has signed the pumping agreement required by s
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;
b. The name of the owner of the holding tank;
C. The location of the property on which the holding tank is installed;
d. The sanitary permit number issued for the holding tank;
e. The dates on which the holding tank was serviced;
f. The volumes in gallons of the contents pumped from the holding tank for each servicing;
g. The disposal sites to which the contents from the holding tank were delivered.
4. This agreement will remain in effect until the owner or pumper terminates this contract. in the event of a change in this contract,
the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the local
governmental unit and the County named above within ten (10) business days from the date of change to this service contract.
Owner(s) Name(s) (Print)
'owners Signatures) Subscribed and swum to me on this date:
1
Tim Bazille
I
1 Today's Date
i
1
P. er s Name (Pri t
f) 1 er's Signa
d- r r F b I�t ( j ��.�� ♦ N��1 H ti� Notary Publlc Signa
t . A .
t - • p Y I
Pumper's Registrallon Number _ •? ' * ' L - -
'7 =' �C� commission Expiration
L 0 1 ��
Drafted by / La perc
t stin
71"
I
57" 93 "
z
r
m
x
3 ..
1 �
0 62" I 6 O I I
m I I
< I < I I
� I m I (
I n I
� r=
1 f I .
D
z
54"
D °
O
m C
1
D C
Z
>l
D �K
-I Z N
m �° D Z O O r z z 1��
p (� D X D O ( I m m D
D Z Z
3 Ooh M Z Zr-N 0 O� D ONZ C) -p- - pmE5ZmZO ODQ T�
m m c r D p - o = C1 p V) o = O o o z m --I r- Z
m c \ a m o � >MZ N > moo >o �o�.. = 0 (n N
G) Ln - -I m z co m o1 _
m N i m (nn r m D Z LnZm 0 1 rr v� cn : mm\ m
m `; � 0 D O � m 0 � 1n -i U) 0 O NO !- 'I O t o N p DAN n 0
0 N D m r n-u too M m co --4 (f) u �' cn u1 � . 0 < n Q
m m Go N - 1< �r - n >> rr ; o N1 6 0 I
0 \ gm U G C ) c mmm 1 r NW c4i n
N I 0 -a m o N m D m D m m o cn ° v A D .�
c > irZr-° rod N
0 >, Z M °' c z map Do o p-1 (n O
n - o N O > v 0 -n O X z n ..- —
i z o r 0 -1 m c� 0 o Z
N m N r 0 M o O O 0 (�
N N 0 r �D A N
m = O m czn U7 r
o -i o m L+
z r� 1 0
m n c m o
O Z O D r
n < r m
3 m � m
m � m
Z m z
1 r
cn m
\ O = W2500 -MR SCALE:1 /4' = i' REV N0. DATE-
rn
o rn MHER callIETE DRAWN BY. SWT
O'n o SEPTIC MANUAL W3716 US HWY10. MAIDEN ROCK. WI 54750 DATE: JANUARY 2008
\• REV. JAN. 2008 800
FILE: W2500 -MR
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County
Attach complet it r not less than 81/2 x 11 inches in . . P n s
include, d horizontal reference poi M Parcel I.D
pe s ons, north arrow, and location >� — _
Please print all information. Ravi by Date
Personal information you provide may be used for aoy Law, d�
Property Owner Property Location
1R m C'- ` e Govt Lot g�W 1/4 $E 114 Z-3 T .2-1 N R ( to jk(or W
Property Owners Mailing Adgrbss Lot # Block # Subd, Name or CSM#
2 S S fA ue. ST CROIX COUNTY N''� N,J!A. N �" -
City ` State Zip OFFICE ❑ City ❑ Village Town Nearest Road
OOC`U'1 le i W i S4e 1 (h 15 ) (Ac .23 -Y
❑ New Construction User Residential / Number of bedrooms 3 Code derived design flow rate L�50 GPD
Replacement ❑ Public or commercial - Describe: t j i1
Parent material � Flood Plain elevation if applicable M
ft:
General comments
and recommendations:
P
1 # ❑ Boring
1 Boring ° Pit Ground surface elev. Q`ta ft. Depth to limiting factor t in.
Soil Applicadon Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#i - Eff#2
i - 0-ft AO .2q I a q,6k 9 5 a
z i 0 k 5 / s 4-4- 91 k 4
Boring # Boring
' ❑ Pit Ground surface elev. G'S . 3 ft. Depth to limiting factor in.
Soli catiorr Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW
In. Munseii Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
I. - io 3 �a S �k K m r^ S �� 4 C-
3- 18 - � 1.5 6 L . 5
a -7-3t 16 '4k G/ m3 s 2 s/r c.
Effluent #1 = BOP > 30 5 220 mgll. and TSS >30:5 150 mg/L ' Effluent #2 = BOD —5 30 mg& and TSS < 30 mg&
CST Nam (Please Print) — polature CST Number
Ms. Loretta Larrabee LsLt CSTM224580
Address Evaluation Conducted Telephone Number
N2089 Cty. Trk.Y, Menomonie, W g*� o q 715/664 -8184
Property Owner 1 x° - Parcel ID # 00 — ID 5 G — 80 — V Page 2 • of _
Boring # ❑ Boring . !,� It
51
Pit Ground surface elev. I �^ .: depth do limiting factor ^ in.
Soft 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#2
`?•S jk 6 /c. 51X s,1 I
F-I Boring # El Boring
❑ Pit Ground surface elev. it Depth to limiting factor ___ -- ____ __ in. Soti 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
E] Boring
❑ Bonng # Ground surface elev. ft. Depth to limiting factor In-
El Pit 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 *E02
* Effluent #1 = BOD, > 30 220 rnglL and TSS >30 150 mg/L * Effluent #2 = BOD < 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 - 2648777.
SBD -8330 (R07M)
Property Owner I Parcel ID # Ofa a — la 5 1� — SO— L � page 2 — • of Z_
Boring # ❑ Boring .j
5
Pit Ground surface elev. M limiting factor �_ In.
4 4 Soil APNIcation Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
In. Munsell Qu. Sz. Cont. Color Gr. SA: Sh, 'EfF#1 'Eff#2
10 S
4k 5j
�•S y2 6 �0 ° t 5 � �Sl f pl G S -', y �' (7
C . S P. 6` a sly st, k �' � ,(O
a Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor . ____.____ in. Soll Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. • M1 `Eff#2
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. "Eff#1 'Eff#2
' Effluent #1 = BOD > 30 220 mg/L. and TSS >30 150 mg/L ` Effluent #2 = BOD < 30 mg1L and TSS < 30 mg&
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- 2648777.
SBD -8330 (R07 /00)
s
SOIL AND SITE EVALUATION REPORT age 3 of 3
JICZ
Tim Bazillelr
SW,SE,S23,T29N/R16W
Baldwin township
St. Croix county
T
i
etta Larrabee
CSTM224580 ,.
LEGEND S
IBM: 100.' top of telephone ?,
pedestal
X — pits
0 — grade elev.
contour J�
No Comm 83
setback problems
Scale 1" — 40' except! o A'
where indicated ' `y
t o r 2 i
5 „ Z" 40
1 0
Part of 144AC 4 ��
t i
<64,.
! - i
1 I
�t
l3_
198 087
—Document Altimber WARRANTY DEED 6 9 1 6 3
KATHLEEN H. WALSH
REGISTER OF DEEDS
Gerald Strobush and Judy Strobush, his wife, conveys and ST. CROIx CO.. MI
warrants to Timothy Bazille and Charlotte Bazille, husband RECEIVED FOR RECORD
and wife, holding as survivorship marital property, the 09 -24 -2002 3:50 PM
following described real estate in St. Croix County, State of
Wisconsin: WARRANTY DEED
EXEMPT # 17
REC FEE: 13.00
TRANS FEE:
COPY FEE:
Recordin a R&IT COPY FEE:
Name and a tfdress
T VV\'k C. hair - i3(.-.Z; I �.
:: ~ •3r,�h q,rF
v ►e t Vt/T
5y 01�k8
002-1055-90,002-1056-20.002-
1056-70, 002 - 1056 -80
(Parcel Identification Number)
See Exhibit A attached hereto and made a part hereof.
This deed is given in complete satisfaction of a Land Contract from Gerald Strobush, a single
man, to Eugene R. Zwald and Susan E. Zwald, husband and wife, as joint tenants. This Land
Contract was assigned by Eugene R. Zwald and Susan E. Zwald, husband and wife, to
Timothy A. Bazille and Charlotte H. Bazille by virtue of that certain Assignment of Land
Contract dated June 21, 1989, and recorded June 21, 1989 in the office of the Register of
Deeds for St. Croix County, in Volume 844, page 30, as Document No. 449000.
This deed is also given in full satisfaction of that certain Land Contract between the parties
dated December 27, 1990 and recorded December 28, 1990 in the office of the Register of
Deeds for St. Croix County, in Volume 889, page 455, as Document No. 465232.
Exception to warranties: all easements and restrictions of record and except any liens or encumbrances
created or suffered to be created by the acts and defaults of the grantees, their heirs, successors, or assigns.
This is not homestead property. Dated this/? day of 04&Vk^ - , 2004. -
`Gera Strobush -5��
Strob
AUTHENTICATION ACKNOWLEDGMENT
IIAC,
Signature(s) STATE OF WISCONSIN •.',!�
ST. CROIX COUNTY
_grs& rsggna11 came before me �, b
n 1 2 L , vow th
authenticated this day of S obush an Judy Strobush t $� BErajr
t}ig.
person(s) who executed t foregq instrtt,.9nd
signature acknowledge a same.
type or print name signature
TITLE: MEMBER STATE BAR OF WISCONSIN type or print name Z2�e
(If not, Notary Public St. Croix County, Wisconsin.
authorized by §706.06, Wis. Stats.) My commission is permanent. (if not, state expiration date:
THIS INSTRUMENT WAS DRAFTED BY )
Thomas A. McCormack *Names of persons signing in any capacity should be typed or
Baldwin, WI 54002 printed below their signatures.
Information Profassionsis Company Ford du Lac, Wisconsin 800.655 -2021