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HomeMy WebLinkAbout012-1037-22-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Divwion ' INSPECTION REPORT Sanitary Permit No: 506254 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)J. Permit Holder's Name: City Village X Township Parcel Tax No: St. Patrick's Catholic Church, Erin Prairie I Erin Prairie, Town of 012 - 1037 -22 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: �M-b 1 / jjU ,a 14.30.17.235C TANK INFORMATION ELEVATION WA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Benchmark l� •� Dosing\ Alt. BM nd Cj, Aeration v CJ BI .Sewer 14 Q Holding S Inlet to 1.7 5' out TANK SETBACK INFORMATION st/ t yet O TANK TO P/ WELL BLDG. Vent to Air Intake ROAD dam' Z ,c Dt Bottom ^ .� p Q�� Header /Man. t (�C Aeration \ / r S Dist. Pipe 70 aJ Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM /6 (y• 3 ID 7 Model Number a In�� �/ DH Ft TDH Lift Friction Los m Head T dA— Forcemain Len Dia. Dist. to e SOIL ABS O TION SYST BED[TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK S EM TO P/L BLDG WELL LAK REAM LEAIZUIN Manufacturer: INFORMATIO CHAM R e Of System: NIT Model Number: DISTRIBUTI SYSTE Header /Manifold istribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia gth 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 -ml Yes 1, No =-No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: � � Inspection #2: / Location: 1880 Cty. Rd. G New Richmond, WI 54017 (SW 1/4 SE 1/4 14 T30N R17W) metes & bounds Lot 77 // Parcel No: 14.30.17.235C 1.) Alt BM Description = 0 p X21 I2��Il.cVU OGA A4-� -�-, A 4 2.) Bldg sewer length = C '� k """ �� - amount of cover = Q-�- ' — q �� Plan revision Required? !; "] Yes No O� Use other side for additional information. Date Insepctor's Signiture Cert. No. SBD -6710 (R.3/97) commeri- ,e.wi.gav Safety and Buildings Division County, 201 W. Washington Ave., P.O. Box 7162 i seon s i n Madison, WI 53707 -7162 Sanitary Permit Number (to be fil ed in by Co.) Department of Commerce 5 O (G Z J Sanitary Permit Application StateTranssac In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the a ropriate gov tal �J 1 10 Z unit is required prior to obtaining a sanitary permit. Note: Application forms for star - POWTS ar oject Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used o dary �`'� purp oses in accordance with the Privacy Law, s. 15.04(l)(m), Stats. 3 I. Application Information — Please Print All Infor UUU Property Owner's e � � � Parcel # '� 11 IN 2007 0/Z - / ©37 -ZZ- 600 Property Owner's jMail Addr s Property Location / 2354. 4 . Z3(, o - ST. CROIX COU�ifY D � Govt. Lot (/ JJ City, State � Code / Phone Number q �� / S 4 - V, Section �!Q ,✓ V JVJ Z Ij�2 /7Z T30 N; R I Eo n rW II. Type of Building (check all that apply) Lot # El or 2 Family Dwelling — Number of Bedrooms Subdivision Name Block # El Public /Commercial — Describe Use ❑ City of CSM Number ❑ Village of� - ❑ State Owned — Describe Use 09 Town of .'� III. Type of Permit: (Check only one box on line A. Complete line B if applicable) - ' ❑ New ❑ System Replacement System Treatment/Holdin Tank Replacement Only El Other Modification to Existing System (explain) Y P Y g P Y g Y ( P ) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber List Previous Permit Number and Date Issued ❑ Permit Transfer to New Before Expiration Owner IV. Type of POWTS System /Component/Device: Check all that apply) ❑ Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) / Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o L 0 �, y New Tanks Existing Tanks 2 o o. U (n tA rn w C7 P, Septic o oldine T ab Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) t P er s ignatu a MP JER5. ness Phone Number -.24 3 Plumber's Address (Street, Cily, State, Zip Code) s 2- / </O ST S_Y'G VI .Coun /De artment Use Onl pproved ❑ ove Permit Fee Date I '71 61 sue Issuing nt Signature e wen Real or Denial $ r /fJ IX. Cond' ' Reasons for Disap nn JS�" i ft 16 CyVVRI�. pp �, Ay Ga,�rv` 72 3b 131 1 5c a� 1. Septic tank,. effluent finer and dispersal cell must all be services / maintained �� W oL,_) as per management plan provided by plumber. 2. AN adbeck requirements must be maintained 1 � Attach to complete plans for the system and submit to the Coun only on paper not less than 8 it x 11 inches in size SBD -6398 (R. 01/07) Valid thru 01/09 a p c -ocQ -e . ......... Left . ... .. ..... . ....... . .. . ..... . ... Pcr MnOW PWIA ... .... . ..... 39Vc] DNi>iondl 3TlI9 080/_89ZSTZ /-00Z/60/90 . . ......... rze ......... ..... . ... 73 ... . ........ ... C4 YU-4� l ov. I fo . . ......... ... Pao KA#M MEN Mr . . ......... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..... ... .... .1 . ... ..... . .. . .. ...... I . . .. ..... . ...... . .... .. . . ....... . - 1-71 zo 39Vd 9Ni>ionNl 3 080Z.89Z9TI- 8b :60 /-00Z/60/90 ' • Safety and Buildings 4003 N KINNEY COULEE RD commerce.wi.gov LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 seo n s i n www.co w mmer gov sb, I t ww.wisconsin.gov Depi artment of Commerce Jim Doyle, Governor Mary P. Burke, Secretary May 09, 2007 CUST ID No. 221471 ATTIC• POWTS Inspector DENNIS J GILLE ZONING OFFICE GILLE TRUCKING & EXCAVATING, INC. ST CROIX COUNTY SPIA 352 140TH ST 1101 CARMICHAEL RD AMERY WI 54001 -2840 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/09/2009 Identification Numbers Transaction ED No. 1393362 SITE: Site ED No. 723008 St. Patrick's Church Please refer to both identification numbers, 1880 County Road G I above, in all correspondence. with the agency. Town of Erin Prairie St Croix County SW 1/4, SE 1/4, S15, T3 ON, RI 7W FOR: Description: Commercial Holding Tank System - 2 tanks / Replacement construction Object Type: POWTS Component Manual Regulated Object ID No.: 1129364 Maintenance required; 850 GPD Flow rate; System: Holding Tank Component Manual, SBD- 10571 -P (R.6/99) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Holding Tank Component Manual for Private Onsite Wastewater Systems" SBD - 10571 -P (R.6/99). • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Comm 83.52(3) The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The existing POWTS shall be properly abandoned per Comm 83.33, Wis. Adm. Code. • The manholes of both tanks shall be < 25' from the parking area/service drive. • Comm 83.22(7) - A copy of the approved plans specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. R ky AP DENNIS J GILLE Page 2 5/9/2007 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 60.00 Fee Received $ 60.00 Balance Due $ 0.00 Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789 -7892, Mon - Fri, 7:15 am - 4:00 pm WSMART', code: 7633 jerry.swim@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. CONCRETE HOLDING TANK DESIGN INDEX AND TITLE SHEET Project S T. PATRICK S CHURCH Owner ST. PATRICK S CHURCH Address 1680 CTY.RD. G NEW RICHMOND WI. 54017 Legal Description SW SE S 15 T 30 N R 17 W- 'Township ERIN PRAIRIE County ST. CROIX Subdivision Name Lot No. Parcel ID Number 012 - 1037-22 -000 Plan Transaction ID Number l nP/ an t��� � pt Page 1 Page 2 .� z e - e7' Page 3 Ke0- P ge 4 Designer DENN Slgnatur � �-- Phone No. 715 -268 -6637 License Number 221471 Date 04/26/07 Resigned pursuant to: Holding Tank Component Manual For POWTS SsD- 10571 -P (8.8/89) Version 4.0(04103) r cCi lv5ti<cE Wage 1 of ! q RECEIVED DIVIS +OW OF SAFETY AND BUILDINGS APR 3 �� 2007 SEE CORRESKONDENCE SAFETY & BUILDINGS Q � r .' -r .../ - / �/ �. k I � A I' G � �� � r ¢ . a• t ' J F/ I I I �' � ,, � � � / � it � � , � �, 1 � � � � � � � / ... / pp � O � 7 t � ►, {I r '� J � . /, 1 // / � / �°"� �/�• � {,� J'- ��1I {� `' r �I � �; �� � � � � �d r, 1 r � HOLDING TANK SPECIFICATIONS if one- or two- family, number of bedrooms ?S .... m " " Non- residential estimated flow per day s °eu a.ss ys ti L ; Minimum holding tank volume required 4600.0 ITotal holding tank capacity proposed (gal) 2000.0 Tank 1 capacity (gal) X for round tanks 2600.0 Tank 2 capacity (gal) huffcutt concrete Tank manufacturer level alarm Alarm manufacturer dvl Alarm model number Tank in Exterior Dimensions in Ibs Ibs in ft Information Liq Level Length I Width Height Tank Wt Anchor Wt S oil Cover Max Bury Tank 48 100 60 60 6600 12900 32. 4 Tank 2 48 100 60 60 6600 12900 32.4 4 HOLDING TANK CROSS SECTION Manhole cover with locking 12" min. 4" min. device and warning label Finished grade �y �y .1� u nction box T F Vent pipe T 18" f Blind plug to seal outlet opening - - - Inlet i r , - 11-1 t2.o n Note: Manhole Service alarm on `I' and vent locations T may be reverse 36.0 in —7 / ZI � -7 2600.0 gal 2000.0 gal Tank 2 Tank 1 3 in. min. bedding under tanks. Anchor tanks as necessary to negate buoyant forces. Electrical as per NEC 300 and Comm 16. Note: All tank joints, and joints between tank openings and piping are sealed watertight. Project: Transaction Number: Page 9- of 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 800.0 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 ruches 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 compl(ance 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 they event that this POWTS faits and cannot be repaired, a code compliant replacement holding nk may be installed in the same location (a new sanitary permit is required for such a repla cement). Con - ta nection to municipal services would also be considered at this time if they are deemed available to the property. 9, If this POWTS is replaced, or its use discontinued, components no longer in use it shall be abandoned t accordance with Comm 83.33 Wis. Adm. Code. n 10.. If there is a problem with, or question about this installation, the following persons should be co R. ( rnstaller .............. .........DENNiS GII.t.B ntaCted: b. Service Provider .................. CASSII..IUS Phone: 1- 715 - 288 -6637 c. Co. Zoning or Health Dept. ST. CROIX CTY. ZONING Phone: 1- 715 - 986 -2743 11. Phone: 1- 715 - 386 - 4680 Project: ST, PATRICK S CHURCH 'Transaction Nurnber: 9 4 Page � of Y 1 'Wisconsin Department of Corp erce ' EIVED301 VALUATION REPORT P age 1 _ of 2 Division of Safety and Bulldin inn} KSt amorrclannA ae Nr ae with omm 86, Wis. Adm. Cade steers Soil Service, [no, Arfaph aampieia efts plan n papernl lfTanY?'1Rah. e. Plan moat County Inolude, but notUmbdto: apoint ,dlrsotlonand St. Croix peroant slope, scale or ) n awl hm to nearest road. Parcel I.D. P/ _ -__ � Personal IMoMOMyouprovlde May beaaedfor &ROMMY pnrpoaea (Privacy Rawl By date Property Owner Property Loce n St. Patrlck's Church �1 _.........___ . _i W. L ot no S W 114 S W 114 S 14 T 30 N R 17 W Property Owner's Mailing Address -- - -- Lot # 810* # Subd. Neme or _ .. _ .. - _ _.. _. 18a Cty Rd_0 n_e City _ _.... State Zip Code Phone Number -^• - CRY T i 1/IRage jfl Town Nearest Road New Richmond I WI 1 54017 716. 684 -3504 Erin Prolde I Cty H G lj New Construction Use: Reatdentlal / Number of bedrooms ...__ 0 Code derived design #ow rate } , 95 i GPl3 jo Replacement Public or commercial - Descrbe:Puhlic Parent material Ridg89 of ground morelinea Flood plain elevation, If applicable General comments and recommendations: Holding tank only due to lack of available scerage. Church with kitchen 180 people, 1 floor drain, 2 employees . Tank size to be determined by dbsfgner and pump contract. 9 Borin Bonn Pit 8 Ground Surface elev. _ 89.00 ft. Depth to limiting factor 33 in. Soli Appllcalbn Rate Him . n bepth omimi ofor Raft llowdpIlon aiwe 9haolure Corwdonw Boundary , Roots _ in. munsell Qv. Sz. M. Color tar. 9z. 3h - im 1 017 10yr311 ngns all Zmsbk mfr ca 1vf .6 . 2 17••33 10yr414 none am Zmsb mfr cs 1vf .4 .6 3 33 -57 5yr4/4 f2d 7.6yr516 si om mo mfi no .2 .6 " Effluent 01 BOO > 30 < 220 mg/L and TSS A30 < 160 mglt Effluent #2 # BOD < 30 mQ/L, and TSS <30 mg/L CST Name (please Pint} nature: CST Number Cstvld J. Steel _. r . ti -. 248986 Address steers Soil Sere re, Inc. — _ _.._ _ ___, Date Evaluation Conducted ^ Telephone Number - 94 2.0( )lh St. Saidwin Wi 84002 4122/2004 715 - 684.500 r t..,, 100 l?j �AI,Ild07, 00 X8.0 119 A89� 981; 514 4g g[ T17J. GO /V7.i1'n Page Zof3 _____ STEEL'S SUIT. SERV INC. navi.� I Steel � -- 1564 Cty Rd OCT CST -POWTS St Patrick's Church New R.ichmond,Wl 54017 Lic #248956 SWIASEIM.SI5,T30N,R17W Bus.(715) 246 -6200 T Town. of Erin Prairie, St (,roix Co. Fax (715) 24 -9372 �� 1 ► . // Legend 197 m 4O1 !! 1 ♦ — Benchmark Rle. 100.00ft _ "� `{ Top of WeII Pipe " • — Alt Benchmark Mo. 00,00ft S f Top of 3/4" PVC Pipe [I Borings Boring Elevations BI - 89.00#t 52 � 00.00fl. B3 — 00.00 ft 0 B4 - 00.00ft Q 6 C 0 0 Q Out U 0 G <D s pas -�0is r � r f �7 zao Q1 7 , F gook 98t 91L YVI me: ? f 11111 401V91 #0 Page 3 of 3 STEEL SOIL SERVI INC. David T. Steel 1564 Cty Rd GG CST -POWTS St Patrick Church New Ri chmond, WI 54017 Lic. #248956 SW1 /4,SE1 /4,S15,T30N,R1.7W BUs .(715) 246 -6200 Town of Erin Prairie, St, Croix Co. Fax (715) 246 -9372 Legend 1 " =40' ♦ —Benchmark Bic. 100.0011 Top of Well Pipe • = Alt Benchmark Ele. 00.00ft Top of 3/4" PVC Pipe ❑ = Borings 2 •°� Boring Elevations r 131 = 89.00ft oaf = oo.00ft _ 3 = 00.00ft DEC 0 000 0 00 o► � 0F r St �Se � L 0 j�:� k�� - -- sti 0 C 0 �d 0 r 0 0 U 0 C 0 Po r - - -- oxrxoz oa Xxo ss 9891 99P 91L am St. Patrick's Catholic Church 1880 Cty. Rd. G New Richmond, Wl 54017 TO Whom It May Concern: The official seating capacity of St. Patrick's Catholic Church is 160 people. L t Dan Donahue St. Patrick's trustee �rnca �l Duzuoz oa .XUD Lq ARAB 9RR 2TL Xy,1 8F';ZT. S�f).L 40 /%7, /ko w ^^ m co n M M0 00 N mw >U) d N N d w°�w y Cl) O aOZ� �WQj Orr Ufnw w59 - W U O U � � �uu (r Swap > x =w lLL HI-o<Q a a z o Q Q' J N w co �o�w WWWao >Cww 2 I No = x n In F ww w OW Z U w 0 W G w F M z a Z LL Z w Q F a aoz w � <oo (x w l W a LL 0. W a W w LL W w LL J � F -F-OIi 7 a CO I I I N U) r LU V / LU w O m O a + w X h l6 d Q 3 L (D _...mow.: ._ LU Z r 4: a Pdv2 "' M II' a i + d 0 N a p `- N c co M N N N a c t'1 0 c w R c N a 0 J O N U 0 � U U) • 7 1CZ, - ( r � HOLDING TANK SERVICING CONTRACT Contract Date S -- / '/ • - c, This contract is made between the HoIdin Tank Owner(s) NaTf(s) and Pumper's Name /L _ !� r /i i /= C .1 D `` /C /­ c l S �Ati , in i, � %J W e acknowledge the installation of (a) holding tank(s) on the following property: (Provi legal descriptions:) % 3<` W % _ ' /e '7 �.� G 1. The owner agrees to file a copy of this contract with the local governmental unit that has signed the pumping agreement required in Comm 83.52(l)(c) 1. Wis. Adm. Code and the approved Holding Tank Component Manual. This agreement will also be filed with the St. Croix County Zoning Department. 2. The owner agrees to have the holding tank(s) serviced by the pumper and 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 access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local goverrunental unit that has signed the pumping agreement and to the County, a report for the servicing of the holding tank(s) on ai semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name.and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank.; e. The dates on which the holding tank was serviced; f. The volume in gallons of the contents pumped from the holding tank for each servicing; g. 'rho disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with local governmental unit and the County named above within ten (10) business days from the date of change to this service contract. Owners) Name(s) (Print) Owner's Signature(s) Subscribed and sworn to me on this date: _' 2 & to Today's Date Syvr ? Pumper's Name (Print) Pumper's Signature Notary Public Signature Pumper's Registralion.Number X00 Commission Expiration aO 13 b�; Q N yi n6y a3a� Parcet #: 012- 1037 -22 -000 07/10/2007 10:24 AM PAGE 1 OF 1 Alt. Parcel #: 15.30.17.235C.236B 012 - TOWN OF ERIN PRAIRIE Current 1X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner ST PATRICK'S CATHOLIC CHURCH O - CATHOLIC CHURCH, ST PATRICK'S 1295 RIDGEWAY HAMMOND WI 54015 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1880 CTY RD G SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 8.000 Plat: N/A -NOT AVAILABLE SEC 15 T30N R1 7W PT SW COR SE SE; TH N Block/Condo Bldg: 21 RODS 3.5FT;; TH W 33 RODS 1.5FT; TH S 21 RODS 3.5FT; TH E 33 RODS 1.5FT TO Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) POB; ALSO COM SW COR SE SE; TH E 16RODS; 15- 30N -17W SE TH N 21 RODS 3.5FT; TH W 16 RODS; TH S 21 RODS 3.5FT TO POB CHURCH & CEMETARY Notes: Parcel History: Date Doc # Vol /Page Type 04/15/1949 587342 430/354 WILL 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/27/1993 Description Class Acres Land Improve Total State Reason OTHER X4 8.000 0 0 0 NO Totals for 2007: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 d ` 9 w � e r.'x r rMr.*a.F � z B� r 3 � + !� t�` r � wt ��' ✓` + yy � a gk tr'� 7 f v °ti,�' F� l o ! $. � +' , d,r .x ;:. t � ,� r � � �� g , �i�.�,er • +� r , `�'7 �,� � > + a r 't �� ks�> � a� �k &1 r � � +�. ti. 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CROIX CO., WI RECEIVED FOR RECORD 07/10/2007 01:55P State Plan Transaction Number - HOLDING TANK AGREEMENT EXEMPT K S % / - r Pe r J(s /.o2�s REC FEE: 13.00 Name — (Owner) Typed or printed PAGES: 2 being duly sworn , states under oath, that: 1. He /she is the owner /part owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume 1 1-3 1 2 Page - 35 - 3 ,4 Document Number St. Croix County Register 13 of Deeds Office: Reco►ttn area = C Name and Return Address /4 A parcel of land located in the ' of the �y /4 of Section , I T 3 47 N - R / 7 W, Town of 3+ /�•So c� P,.>r -r: -4-t G C 2�!? j9 , A- i= > St. Croix County, Wisconsin, being duly 2.. c,.1L Soot 7 described as follows (include lot no. and subdi ' 'on/CSM or detailed legal description): See- Q 4c.0 V e Parcel Identification Number (PIN) Agreement Date : WV_ - V_ 4 00 7 We acknowledge that application is being made for the installation of (a) holding tank(s) on the above described property or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private onsite wastewater treatment system as permitted under Ch. Comm 83, Wis. Adm. Code, or Ch. 145, Wis. State. 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, Stats., the governmental unit (Town) 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. 66.0703. Scats. 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 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, 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 governmental 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 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 properly maintained. 6. This agreement will remain in effect only until the county office responsible for the regulation of private onsite wastewater treatment systems certifies that the property is served by either a municipal sewer or a private onsite 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 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: f �) S A Te / c ;S Nota ized Owners Signature(s) Notary Public a . n - Governmental Unit Official Name, Title - Please Print My Commi Expires p a_.v w-T s tit �c1� -� �- S Governmental Unit Official Signature Drafted by: Personal information you provide may be used for secondary purposes (Privacy Law s. 15. ip)] • 'y "THIS PAGE IS PART OF THIS LEGAL DOCUMENT — DO NOT REMOVE" f1 j x C O 1 f This infannafion must be completed by submitter. document dife name 8 return address. and PIN (if required). Otherinlormallori�3lich as No te Use of this cover page adds one page to your document and $2.00 to the recording fee. Nhsconsin Statutes, 59.597. St. Croix County Holding Tank Agreement Page 2 PARCEL #: 012 - 1037 -22 -000 Owners: Catholic Church, St Patrick's Tax Address: St Patrick's Catholic Church 1295 Ridgeway Hammond WI 54015 Legal Description: SEC 15 T3 ON RI 7W PT SW COR SE SE; TH N 21 RODS 3.5 FT; TH W 33 RODS 1.5 FT; TH S 21 RODS 3.5 FT; TH E 33 RODS 1.5 FT TO POB; ALSO COM SW COR SE SE; TH E 16 RODS; TH N 21 RODS 3.5 FT; TH W 16 RODS; TH S 21 RODS 3.5 FT TO POB CHURCH & CEMETARY 2of2 - 1428 �� RECEIVECSoI EVALUATION REPORT Page t o f 2 Wisconsin Department of Co m erce Division of Safety and Building in accordance with omm 85, Wis. Adm. Code Steel's Soil Service, Inc. DEC 0 � ,QYrtc County Attach complete site plan n paper not less than /: r hes in ize. Plan must St. Croix include, but not limited to: ertica�apd bgrj�erence point ( ), direction and parcel I.D. percent slope, scale or di emsio � ONI dWtj*on and istance to nearest road. _ /' Plea F �' Revie By . Date v , / S � Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location v St. Patrick's Church C Govt. Lot na SW 1/4 SW 1/4 S 14 T 30 N R 17 W Property Owner's Mailing Address Lot # Block # Subd. Name or CW 188OCty Rd G nasty y City State Zip Code Phone Number City Village 16 Town Nearest Road New Richmond WI 1 54017 1 715 - 684 - 3564 Erin Prairie Cty Hwy G J J New Construction Use: Residential / Number of bedrooms 0 Code derived design flow rate 951 GPD Replacement t Public or commercial - Describe: Parent material Ridges of ground moraines Flood plain elevation, if applicable na General comments and recommendations: Holding tank only due to lack of available average. Church with kitchen 160 people, 1 floor drain, 2 employees . Tank size to be determined by designer and pump contract. Boring # Boring 16 Pit Ground Surface elev. 89.00 ft. Depth to limiting factor 33 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDt t= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 1 0 -17 10yr3/1 none sit 2msbk mfr cs 1vf .6 .8 2 17 -33 10yr4/4 none sicl 2msbk mfr cs 1vf .4 .6 3 33 -57 5yr4/4 f2d 7.5yr5/6 sl om mfi mfi na .2 .6 * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < mg/L CST Name (Please Print) Signature: CST Number David J. Steel 248956 Address Steel's Soil Service, Inc. Date Evaluation Conducted Telephone Number 994 200th St., Baldwin, WI 54002 4/22/2004 715-6845680 Page 7—of 3 STEEL'S SOIL SERVICE INC. David J. Steel 1564 Cty Rd GG CST -POWTS St Patrick's Church New Richmond,WI 54017 Lic. #248956 SW1 /4,SE1/4,S15,T30N,R17W Bus.(715) 246 -6200 Town of Erin Prairie, St. Croix Co. Fax (715) 246 -9372 Legend 1" 40' ♦ = Benchmark Ele. 100.00ft lu e (/ if - 2' Top of Well Pipe • = Alt Benchmark Ele. 00.00ft Top of 3/4" PVC Pipe ❑ = Borings Boring Elevations B 1 = 89.00ft B2 = 00.00ft O B3 = 00.00ft B4 = 00.00ft O s O 7�k O 0 �u�c,�� a G O OO 0 O t ,p R tes (�s ���� O C � O Page 3 of 3 STEEL'S SOIL SERVICE INC. David I Steel 1564 Cty Rd GG CST -POWTS St Patrick's Church New Richmond,WI 54017 Lic. #248956 SW1 /4,SE1 /4,S15,T30N,R17W Bus .(715) 246 -6200 Town of Erin Prairie, St. Croix Co. Fax (715) 246 -9372 Legend 1" = 40' ♦ = Benchmark Ele. 100.00ft Top of Well Pipe • =Alt Benchmark Ele. OO.00ft Top of 3/4" PVC Pipe ❑ = Borings Boring Elevations o ft- B 1 = 89.00ft u = 00.00ft 3 = 00.00ft 00 00 -- O 0 0 0 4= 000 O gI�G3�ofv q S, �,,g'/ O O O Pa 5 O O O O O O C O O St. Patrick's Catholic Church 1880 Cty. Rd. G New Richmond, WI 54017 To Whom It May Concern: The official seating capacity of St. Patrick's Catholic Church is 160 people. S Dan Donahue St. Patrick's trustee Parcel #: 012 - 1037 -22 -000 04/05/2007 09:40 AM PAGE 1 OF 1 Alt. Parcel #: 15.30.17.235C.236B 012 - TOWN OF ERIN PRAIRIE Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - CATHOLIC CHURCH, ST PATRICK'S ST PATRICK'S CATHOLIC CHURCH 1295 RIDGEWAY HAMMOND WI 54015 Districts: SC = School SP = Special P erty Address(es): ' = Primary Type Dist # Description " 1880 CTY RD G SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 8.000 Plat: N/A -NOT AVAILABLE SEC 15 T30N R1 7W 8AC SE COR SW SE SW COR Block/Condo Bldg: SE SE AS DESC IN 430/354 CHURCH & CEMETARY Tract(s): (Sec- Twn -Rng 401/4 1601/4) 15- 30N -17W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 430/354 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/27/1993 Description Class Acres Land Improve Total State Reason OTHER X4 8.000 0 0 0 NO Totals for 2007: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 a ° ry ` O 4z; 0. 0 tl @ y 0 Q I�, C j _3 N r0 N E l p N U O_ Q m� N f0 arc+ O) C 0 o _N U [: IZ _ 3 c r N C 10 — a3 _N 't N T O Z N C Q C 7 (9 N LL O 0 N N O O N y N Q N 'p � C O Z N r W cn w O v E Z `m M a m o z t ° c o N m Z c � LO N Co 3 IO N ( — N a N C a (n L O E O U Q O L Z m Z N U � C : 3 .. E z� s .. a - od a c N d a � `i o o a Y ° 333 °-Z 00 O O O 'a • I O N <n -i u a p c � � Z W O O U ° ° to hy' U d QI Z W O 3 O C I N C w+ p ''. (0 O 'O O R r N M~ N C C [ \ N N N Y N E E O 0 c d q ' �I N M • A O N O O y O W (n O Z Z O `C 7 � ij L a • ca a m ' m y CL