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HomeMy WebLinkAbout042-1085-30-310 Wisconsin Department o Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division r St. Croix INSPECTION REPORT ermit No: GENERAL INFORMATION (ATTACH TO PERMIT) 569507 0 Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)]. ID No: Permit Holder's Name: City Village X Township Roscon Pro erties LLC, C/o Richard Stout No: CST BM Elev: Insp.BM Elev: BM Description: Warren, Town of 042-1085-30-400 l O 0 / wn/Range/Map N. TANK INFORMATION (�8 d_ 31.29.18.476A80 ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic B nchmark Alt. BM Aeration Bld �eer, 1 IN Holding Gy e� St/Ht Inlet / TANK SETBACK INFORMATION St/Ht Outlet TANK TO%/ WELL_. BLDG. Vent to Air Intake ROAD Dt Inlet �C Septic r Dt B ottom Dosing eader/ a�Aeration Dist. Pipe Holding Bot. System �y S -3 PUMP/SIPHON INFORMATION Fjpgl Grade n� �F 14 ManufacturerQV S �YZ T Demand St Cover a Model Number 3 CA&7& 5 X11 t jkt y r TDH Lift Friction Loss stem Head TD H Ft Forcemain Length Dia. Dist.to Well "�� SOIL ABSORPTION SYSTEM -7-1—C C%C7r (�� BEDITRENCII Width Length DIMENSIONS r r No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth SETBACK SYSTEM TO P /L BLDG WELL LAKE/STREAM EACHING actuyer: T e Of System: HEAC I O tur -7�f f -I- ZJ � � 1 � UNIT Model Number: BUTTON SYSTEM , Header/ nifpld f Distribution Length/ �ia t( 0 Pipes) I f x Hole Siz x Hole Spacing Vent to Air Intake Length Dia Spacing SOIL COVER x Pressure Systems Onl Depth Over Y Y xx Mound Or At-Grade Systems Only Bed/Trench Center I Depth Over xx Depth of xx Seeded/Sodded Bed/Trench Edges xx Mulched Topsoil Yes L_,j No Yes ❑ No COMMENTS: (Include code discrepencies,persons present,etc. Inspection#1: /1 / Inspection#2: Location: 951 70th Ave. Roberts,WI 54023 (NW 1/4 NE /4 31 T29N RI NA Lot 8 t� `'� (' 1 Parcel No: 31.29.18.476A80 1.)Alt BM Description= -Fop � V f T f ca kat 2.)Bldg sewer length= r -amount of cover= cr e At WA LLA Plan revision Required? Yes o _ Use other side for additional information. J L �� SBD-6710(R.3/97) Date Insepctors Signature i Cert.No. e PLOT PLAN PROJECT Roscon Properties ADDRESS 1353 Awatukee Trail Hudson Wi 54016 NW 1/4 NE 1/4S 31 /T 29 N/R 18 W TOWN Warren COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE 1/26/14 BEDROOM 6 CONVENTIONAL )00( IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1250/750 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE _LOAD_RATE .7 ABSORPTION AREA 1337 # of chambers 66 , BENCHMARK V.R.P Top of wood post � ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE 0 ,p, Same as Benchmark SYSTEM ELEVATION 87.0/86.5/86.0 4.5' below qrade 70th Ave All piping shall be SDR 30/34,within 10' of tank, piping shall be Schedule 40. I/ o oom Scale is 1" = 40' IDD unless otherwise Sa Du lex noted r Vent >6» Quick4 Standard ?4' er Leaching Chamber with 20.0 ft2 of Area ong 12" 5.6ft^2/pair of end caps �o Huffcutt Combo Tank 3 4„ p. Grade at System Elevation 0' /2.s-0 r 7 s� 20-L' x` 30' 3-3' X 90' cells with>3 spacing B.M. B-3 7 91' 23 89' area of poor soils 10 B-2 90 B-1 15 7% Slope 17' Property Line r � County c rn =Ind Services Division �� t � Washington Ave Sani tary Permit Number(to be filled in by Co.) O. Box 707 ��,WI 53707-7162 `v\ .- State Transaction Nutt�ber. Sanitary Permit Application N g In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental u is required prior to obtaining a sanitary perm fe:Application forms for state-owned POWTS are submi to �4ddress(if d e than mailing ddres the Department of Safety and Profession a Personal information you provide may be used for seco ry �e� 9 / f*A purposes in accordance with th iv L .04(1 I. Application']nfotntat1 Pri Information / Property Owner's Name ` H� RO�� 7 2 p ?Q O J 7 rty Location / ��� /L Property Owner's Mailing Address City,State Zip Code Phone umber / /. /a Section le Type of Building(check all t at apply) Lot# ubdivision Name or 2 Family Dwelling-Number of Bedrooms Q L Block# ❑Public/Commercial-Describe Use IC ity of -jp_' M Num r `� [I Village of ❑State Owned-Describe Use 2vr/ Town of .f VY 1I1.Type o ermit: (Check only one box on line A. Complete line B if appy ble) A. ew System ❑Replacement System ❑Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(explain) B. ❑ List Previous Per mit Number and Date Issued Permit Renewal ❑Permit Revision ❑Change of Plumber C1 Permit Transfer to New Before Expiration Owner IV.T e of POWTS S stem/Corn onent/Device: Check all that a)Ply) L� on In-Ground ❑ Pressurized in-Ground At-Grade 2 in.of taS 1 Moun <24 inT i31e soil a ent evice ex am) ❑ Holding Tank ❑Other Dispersal Component(explain) L` V.Dis ersaVTreatment Area Information: Dispersal Area Proposed(sf) System El vation Design Flow(gpd) Design Soil Application Rate(gpdsf) Dispersal Area equired(s� O� O 3 ,L 6, Capacity in Total #of Manufacturer 2 c Vl.Tank Info E ° ' Gallons Gallons Units J2�e � Dom-Sf�Q,� � � U j H � New T Existing Tanks ,�`'""c✓� V '= ° ' T' w U Septic or Holding Tankro Dosing Chamber VII.Responsibility Statement-I,the undersigned,a u e responsibility for installation of the POWTS shown on the attached plans. (Print) Plu ignature MP/MPRS Number Business Phone Number Plumber's Name Plumber's Address(Street,City,State,Zip Code) 2 12 V11 Coun /De artment Use Onl I in Agent i nat e Permit Fee ,fp, Date Issu g g g Approved El Disapproved $ ❑Owner Given Reason for Denial b /� // , 77'� IX.Conditions of Approval/Reasons for Disapproval L3Q - 3 SYST("M OWNER: -Ap dye 1.Septic tank,effluent filter and Z _ 3439- dispersal cell must be serviced/maintained as per management plan provided by plumber. 1 2-All setb1:11 r it must be maintained as per applicable cM&W?QN+ pns for the system and submit to the County only on paper not less than 8 tl2 x I1 inches in size SBD-6398(R0313) Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 1/26/14 Owner: Roscon Properties Location: NW 1/4 NE1/4 S31 T29 N,R18W Lot 8 70th Ave Warren System type: In-ground absorbtion system(conventional) Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Specification)Shee 8-10. Soil Test Signature i License number' 26900 Cross Section of Quick 4 Standard Leaching Chamber Typical cross section for 2 of 3 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.8ft^2 pair of end plates To be >1' above grade Finish grade elevation Typical Installation 91,0' at 33 t Grade ent 4" AV X30/34 Septic Tank .1ven �� 5' Grade at System Elevation 3451 Grade at System Elevation 3415 Spacing 5' 3-3' X 90' Cells Observation tubeNent Same on other end To be located on end of Cells %A B System elevations: C A--87.0 B__86.5 22 chambers per cell C__86.0 PLOT PLAN PROJECT Roscon Properties ADDRESS 1353 Awatukee Trail Hudson Wi 54016 NW 1/4 NE 1 14S 31 /T 29 N/R 18 W TOWN Warren COUNTY ST.CROIX MPRS Shaun Bird 226900 1/26/14 DATE BEDROOM 6 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 12501750 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 1337 # of chambers 66 BENCHMARK V R.P. Top of wood post ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 87.0/86.5/86.0 4.5' below qrade 70th Ave All piping shall be SDR 30/34, within 10' of tank, piping shall be Schedule 40. ro 6 Scale is 1" = 40' oom unless otherwise Du lex � noted Vent 80' >6" Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 4' Long 12" 5.6ft^2/pair of end caps Huffcutt Combo Tank 3491 Grade at System Elevation 50' 30' 3-3' X 90' cells with>3' spacing B.M. B-3 Vents 70' 91[area 30' 89' 10 gm o 90' of poor soils 10 B-2 B-1 5 7% Slope 17' Property Line r • ter.+...-.... �\ '_"""': • • • , FAM f`/JJJJ///j/iii ///icy y ✓/�////// / /RM ,/ lool ,,. Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings �� IM accordance with Comm 85,Wis. Adm. Code , County Attach complete site*1nj r n ss than 8112 x 11 inches in size.Plan must include,but not limi rtica �2Q d horizontal reference point(BM),direction and (J percent slope,scale a ons,north arrow,and location and distance to nearest road. i Z Please print all information. r X C by Date cc Personal infonnabon you provide may be used for secondary purposes(Privacy law,s.15.04(1)(m)). UN � Property Owner Property Location Govt.Lot 1/4 1/4 S T N R JE( W Property Owner's Mailing Address �� Lot# Block# Subd. Name �� 5 J u/w City State Zip Code Phone Number ❑City ❑Viil ge fiRZoA r4earest Road tvl � Dl ( ) ems✓ ���`'� New Construction UseeAResidential/Number of bedrooms Code derived design flow rate— v GPD ❑Replacement ❑ Public orr�°mm�eraal-Describe: -_— Parent material 0GL�7�C�C - Flood Plain elevation if 9pplicable, General comments /� �,, ) f�P V ✓ X ( and recorrurrendations: >"/ `5`4,e �" 1,11 3 t 3 System Type System Elevation / ✓ �� 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/fP in. Munseli Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 -Eff#2 -57 16 /1701 i ® Boring# ❑ Boring pit Ground surface elev. �y J 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#22 ®- 1 r3/2 / S Y Fr G m - . G ID rsl 4r M ► 7 Effluent#1 =BOD >30 1220 mgi(L and TSS>30:5 150 mVII Effluent#2=BOD <30 mg&and TSS<30 mg/L CST Name(Please Print) Si CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 —a --�� 715-246-4516 J Property Owner_ Parcel ID# Page of Boring# ❑ Boring Q'Pit Ground surface elev. I ft. Depth to limiting factor in. r*Eff#1 il lication 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 'M ,-'A / S r . c. .q 7- 1 ,V V � F-1 Boring# ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. -'SoiApplication 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 F-1 Boring# E] Boring El Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon ')epth 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 =BOD5>30<220 mg/L and TSS>30<150 mgA. '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. SOD-8330(8.6/00) Soil Test Plot Plan Project Name Richard Stout Shaun B' Address 1353 Awatukee Trail Hudson Wi 54016 CS #226900 Lot 8 Subdivision --------- Date 6 4/13 NW 1/4 NE 1/4S 31 T 29 N/R18 W Township Warren Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of wood post System Elevation TBD *HRPSameasBenchmark 70th Ave Scale is 1" = 40' unless otherwise noted 250' B.M.* B-3 70' 91' 30' 10' Area of poor soils 89' B-2 90' B-1 5' 7% Slope 17' Property Line * H . •I CS INSTRUCTIONS y EP z Cary Iff"W raw crier 111"1119 91W atom Whitt pipe to erra"it h: Ite44ored mWor ter. Opening. If ngt,,*"biter tnrWYt frioro 0104 ibto th„• talaic Ilerlrq/w t11e o11Not m eelWbnk kwdtd i b)itdditlrora111lpe was the Outlet lYhle. .V IFPI d WtdW no Cape 15 6+t MIt1 dry fiE ed anti the Outlet YiUe,aswad7 m tlay eweya of&A-W&pipe needed Lot bwact,t1te rfi4W to tira t&nk turd W91l If UOUIrig the "Heald#Wpk"twtd idde support.I4 sldo'stlpport nwthud.is nut utilind, protmad to A"W. a•rrN 3 For lubUtilataus tttlihWay tin oplie l SUpplolr0nt4 aids sayrtwrt_ seAuer+t wee t"%•-arrrstr 1SItw yail:w LhO Mtbr tam- If We sUbpW2 Matbtld ijj sot uN ed,profted to dup Emu. SWVOrt WtWd ti s Met case nfkto the carWdgv YMtr the C9tre, Inre9SIM duet until th mat,kA*erltIathe 1a►ttttiva, ur .y if m tl95 sw krdr is rdilraad_ inrenrt fusty tby flibs'find lock try turnmij 1. '1'lld effluent tepee alaeauld be Wam od overt'tk td tiro iaeptic tynit 16 sarvineai. 2. gpetr the outlet ucc"w epar,btu to inspott Lhe bank,and 111tur ` H. Pumps tfaa saptic tank oampletrely,frr8king Vor s to relrmwil tho dudo IasVur tae the bartMwn of the sell(oad"at jut tire'st'tnn drill o/quut4, u a. Owe tow atrttwnt level has bum*lowered below thu inYrtlrt tlf tllo t outlet pipe,fintdy pull up uh the Mter hyrtdle to 400Aydgo the cadrtekigo fmko t6 ulme. IM• 5. Slide the rortrhlge Up i0d aft It of t6S+.oie f W deaniny. t►. tr it VA6 swlreh t 9ntweted to anrr Wwhv 15"at,the SWUM t4iw W he rwnw*d by tv"Alig wmilintordudmim eftu kind degued d 4 c Wm Walter only. + 7. While hWOng the tnrt*ei my ifs side(lame flat suo*,Q(caeiary ua down)oust•lino 40MM op"I$v ri KM ofl tha Gait*Ue tWth tifintnf aniy,r0skiny'sure an eaplbugtk teelimkl Is"Mod back Into the tank. +iajtw•. .t 8. If VRS awitvh is utW AW,top4 M by ttrtltlg 11ni into�blrl'ildld 9, ltesart tW filter c5rhitigie btuck 040 the Ctrs,ilrei dae dwm-omit tite filter lucks lnko tlrn hokkoora of dw Chaim. Ya Ia.Replece Wei mcm We ilIMM3 U08111110 rid file(AML y,ir••rant";•..w at'Y4;4W'irLi'�446 'kt'4` ''117J t irFt'i1::•Y:aildlxN"' w WWJM9r tilglatmAxslpll. -MMMI M(653-4583) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page l of v FILE INFORMATION SYSTEM SPECIFICATIONS 6/ __ _ n -gal ❑ NA Owner -- 7 , n Septic Tank Capacity - `�- al _- - 5555 !SOS CUB-! ,.f r�.e�d�.—._� Permit# S Septic Tank Manufactul er J NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms nd ns- _ ❑ NA Effluent Filter Model - _ `_- `-`--_- NA Number of Public Facility Units `,6,NA Pump Tank Capacity --- _ al _NA Estimated flow(average) - �D� gal/day Pump Tank Manufacturer- NA Design flow(peak),(Estimated x 1.5) /��'� gal/day Pump Manufacturer - _-`-- 0 NA S Application Ra�.e _ _ al/da Iftz Pump Model NA ' Standard Influent/Effluent Quality Monthly average" Pretreatm:ant Unit NA Fats,Oil&Grease (FOG) _530 mg1L 0 Sand/Gavel Filter LI Peat Filter Biochemical Oxygen Demand (BODs) :5220 mg/L ❑NA ❑ Mecharical Aeration 13 Wetland Total Suspended Solids (TSS) .:5150 mg/L ❑ Disinfection 11 Other: ----- Pretreated Effluent Quality Monthly average Dispersal Geli(s) CJ NA Biochemical Oxygen Demand (BODs) 530 mg/L. In-Ground(gravity) CI In-Ground(pressurized) Total Suspended Solids (TSS) :530 mg 11- _AA ❑At-Grace ❑ Mound Fecal Coiiform(geometric mean) 5104 cfu/100m! 0 Drip-Line _—- ❑Others—---_--__ - - -Other: O NA Maximum Effluent Particle Size X in dia. ❑ NA ---_---- - _ -_ - ____------ Other------- ..-555.5._ -- ------- NA Other. 0 NA 'Values typical for domestic wastewater and septic tank effluent. Other: - ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency 's) Inspect condition oi`tank(s) At least once every: 13 Mont_— _ s (Maximum 3 ears_ y ) ❑ NA Pump out contents of tank(s) - When combined sludge and scum equals one-third(�)of tank volume - _- U NA _- ._--.—"---- -- JA ❑ month!s) Maximum 3 ears DNA Inspect dispersal cells) At least once every: 7�'m th ( y )C),months s) NA Clean effluent filter t least once every: f, ear(s, _ Inspect pump, controls&alarm At least once every: ❑months s}- NA P P p ❑year(si_.-------- ---- ---- Flush laterals and pressure test At least once every: q year(s) Other: - - -- At least once every: -- - d months s) NA D year(s)_ --- _-- -- NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber;Master Plumber Restricted Sewer;POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s)to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent or the ground wirface. The dispersal cell($) shall be visually inspected to check the effluent levels in the observation pipes and to checi: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 (6)or more of tl ie 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, mecharica!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 ctmpletion of an!,service event. Page v_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 Barrage 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 conditi ons are frozen at the infiltrative surface. During power outages pump tanks may fill ab3ve 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 thia 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 Bump 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; condoins; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scrapi; 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-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 proiected 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 i;omply with the rules in effect at that time. ❑ A suitable replacement area is not amailable 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. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed Powrs. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following n-moval 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 ANDIORI INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC,PUMP OR OTHER TREATIMENT TANK UNDER ANY CIRCUMSTANCES. Dw:ATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK 14AY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS -POWTS INSTALLER POWTS MAINTAINER Name c� <n Name Phone 1 a� -' �� 1 L� Phone 7)J--�� SEPTAGE SERVICING OPERATOR P MPER LOCAL REGULATORY AUTHORITY Name _1 Name — Phone )v Phone This document was drafted in compliance with chapter:lPS 383.22(2)(b)(1)(d)&(f)and 383.54(1),(2)&(3),Wisconsin Administrative Code. ST. CROIX COUNT'°' SEPTIC TANK MAINTENANCE /kGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 0 se"—, -g Mailing Address Property Address �5 Q Ave- (Verification required from Planning&Zoning Department for new on on.c _____ City/State D �e� t ylT- Parcel Identification Number 4�(1Z- /O 3 d LEGAL DESCRIPTION Property Location 2 g P Y /�/4 ,�-�- '/4 , Sec.J C , T �/ N _K_W, Town of ,— Subdivision , Lot# Certified Survey Map #— �0 % Z-3 , V'(Aume Z ,Page# Warranty Deed# i/Z32oG/ (Q — Volume , Page# Spec house es no Lot line:4 identifiable yes no 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 wasCe disposal system Owner maintenance responsibilities are specified in§Comm. 83.52(1)and in Chapter 12-St. Croix County Sanitary Ordinance. The property owner agrees to submit to St.Croix County Planning&Zon:mg 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. T/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 Commerce and the Departrn.ent 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. I/we arn/are the owner(s)of the property described above,by virtue of a warranty deed recorded in Register of Deeds Office, Number of bedrooms l 96/1V SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being rt-Toked 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.08/05) STATE BAR OF WISCONSIN FORM 2 - 1998 II 8 2 8 1 6 9 // WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS Document Number _ ST. CROIX Co., WI This Deed, made between RECEIVED FOR RECORD RICHARD O. STOUT and JANET P. STOUT i! 06/23/2006 02:45PH husband and wife, WARRANTY DEED Grantor, EXEMPT M 15S and ROSCON PROPERTIES LLC, a Wisconsin Limited Liability Company, �i REC FEE: 11.00 TRANS FEE: COPY FEE: Grantee. �i CC FEE: Grantor,for a valuable consideration,conveys and warrants to Grantee the following PAGES: 1 described real estate in St. Croix County, State of Wisconsin: Parcel G II9tx;ordnyArea Names and Return Address Located in Part of the NE 1 /4 of the NE 1 /4 an4 Di =k Stout the NW 1 /4 of the NE 1 /4 of Section 31 , 1353 Awatukee Trail T29N, R 18W, Town of Warren, St. Croix Hudson, WI 54016 County, Wisconsin, except Certified Survey Map recorded November 13, 2002, in Vol. 16, page 4411 , aS Document #698254. This parcel contains 36.42 acres excluding R/W and except CSN. 042-1085-30-000 Parcel Identification Number(PIN) This is not homestead property. (is) (is not) i Exceptions to warranties: eaements, restrictions, rights-of-way and covenants of record. Dated this 1.st day of June 2006 (SEAL) /�L (SEAL.) i Richard O. Stout Janet P. Stout (SEAL) _ (SEAL) i AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, St. Croix ' County !I authenticated this day of Personally came before me this 7th _ day of •71Le .2006 -, the above named Richard O Stout and Janet P. 4 O � TITLE: MEMBER STATE BAR OF WISCONSIN to (If not, me known to be the person S who executed the foregoing I' authorized by§706.06,Wis. Stats.) Instrument acknowledge the same,/ THIS INSTRUMENT WAS DRAFTED BY l G '14? Janet P. Stout 1353 Awatukee Trail Hudson, WI 54016 Notary Public.State of Wisconsin My commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not O� ) necessary) --- - -— P9f$A�/if�f7lra —-- y Names of persons signing in any capacity must be typed or printed below their signature, (� 1 oVf ARRANTY DEED STATE BAR OF WISCONSIN Notar PuWf�nsin Legal Blank Co„inc. FORM No.2-1998 Milwaukee,Wis. State of Wisconsin 984293 BETH PABST REGISTER OF DEEDS z ST. CROIX CO., WI "' RECEIVED FOR RECORD Z BEARINGS ARE REFERENCED TO THE 08/15/2013 3:22 PM 'n NORTH LINE OF THE NE1/4 OF SECTION s 31 BEARING N89°07'20-W(ST.CROIX z EXEMPT #: m COUNTY COORDINATE SYSTEM). 28 m g REC FEE: 30.00 0 0 COPY FEE: 3.00 UNPLA7TED LANDS Z z PAGES: 2 m m NORTH-SOUTH 1/4 LINE _ SOO°15'58"W 861.61 m 417.59' m g ^� 411.02' 33.00 • T O Z 828.61' - 444.02' -- 1 n O T m N n nr IJ w r z , cn n m C�Q v'ZO► o o 'S rz- O oa N �� ° "°° -i � z n I+ N n O Z O T �\O� o 411.02' 33.00' j0 i0 0-� 9 c m �\� 1 �i t� v n = O 0 207.96' 203.06' co -n m .�� N00°15'58"E 444.02' iTi T> Z 01 N m N \�� _0 I I� //� M m T i+ \�: r1 IN C jam$ �1 N mZ � � w S 9- N o Rf D !� co m w n D r sQ 0 "m C. co m Cn y m No & :9 D iIV A y2 CD (� m T L p0 lf� C9,— — — O O ear cn a M r . 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Parcel M 31.29.18.476A-70 042-TOWN OF WARREN Current OX ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type #of Units 05/02/2012 00 0 Tax Address: Owner(s): 0=Current Owner, C=Current Co-Owner RICHARD O&JANET P STOUT O-STOUT, RICHARD 0&JANET P 1353 AWATUKEE TRL HUDSON WI 54016 Property Address(es): '=Primary Districts: SC = School SP=Special Type Dist# Description SC 2422 SCH D ST CROIX CENTRAL SP 1700 WITC Notes: RETIRED 042-1085-10-100, 042-1085-30-000; CSM 25-5850 TAKES ALL NEW 042-1085-30-100 LOT 5, Legal Description: Acres: 21.010 042-1085-30-200 LOT 6, 042-1085-30-000 LOT 7 SEC 31 T29N R18W NW NE CSM 25-5850 LOT 7 Parcel History: �� Date Doc# Vol/Page Type l 0 `l 05/02/2012 955511 CSM �S 45q 5D 05/02/2008 873946 QC 06/23/2006 828169 WD 02/21/2006 818902 EZ-U more Plat: '=Primary Tract: (s-T-R 401/4 1601/4) Block/Condo Bldg: "5850-CSM 25-5850 042-2012 31-29N-18W LOT 07 2013 SUMMARY Bill M Fair Market Value: Assessed with: 228563 Use Value Assessment Valuations: Last Changed: 09/30/2013 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 15.000 2,400 0 2,400 NO 05 UNDEVELOPED G5 6.010 6,000 0 6,000 NO 05 Totals for 2013: General Property 21.010 8,400 0 8,400 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 Parcel M 042-1085-30-300 01/27/2014 12:15 PM PAGE 2 OF 2 Parcel History: cont. 09/16/2002 690260 1976/001 WD 10/30/1998 590360 1371/554 CO 12/05/1994 524052 1104/621 OR 03/30/1994 514697 1071/235 PR VOL 1: 71-PAGE568 590366 WARRANTY DEED Document Number. E .ISTER!F.+ OFFICE ST;' CR0OC t;7), WI OCT •wry Riearm Retum Address: O 4 T 3 0 1998 ,C'�l 1� -��z- a'3o P ►� Re sfer of Dow" Parcel I.D.Number(PIN): 042-1086-10;042-1088-20;042-1086-40;042-1085-50; 042-1085-60;042-1085-40;042-1085.20;020-1108-60: 020-1108-80;020-1108-70;020-1108-80 This Deed, made between Frederick G. Lenertz Land and Cattle Company, L.L.C., a Wisconsin limited liability company, Grantor, and Richard O. Stout and Janet P. Stout, husband and wife, as survivorship marital property, Grantee, Witnesseth, That the said Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin: NE 1/4 OF SECTION 36, TOWNSHIP 29 NORTH, RANGE 19 WEST, ST. CROIX COUNTY, WISCONSIN THAT LIES SOUTHERLY OF INTERSTATE HIGHWAY 94. NW 1/4 OF SECTION 31, TOWNSHIP 29 NORTH, RANGE 18 WEST, ST. CROIX COUNTY, WISCONSIN LYING SOUTHERLY OF INTERSTATE HIGHWAY 94 EXCEPT CERTIFIED SURVEY MAP IN VOL. 1, PAGE 221 AND EXCEPT PART IN VOL. 634, PAGE 138 AND EXCEPT PART IN VOL. 913, PAGE 201. NE 1/4 OF SECTION 31, TOWNSHIP 29 NORTH, RANGE 18 WEST, ST. CROIX COUNTY, WISCONSIN LYING NORTHERLY OF 65TH AVENUE AND SOUTHERLY OF INTERSTATE HIGHWAY 94 EXCEPT PART IN VOL. 913, PAGE 201. This is not homestead property. Together with all and singular the hereditaments and appurtenances thereunto belonging: And Grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements and restrictions of record and will warrant and defend the same. Dated this 30th day of October, 1998. FREDERICK G. LENERTZ LAND AND TRANSFER CATTLE COMPANY, L.L.C. Steven B. Goff, Power of Attorney Frederick G. Lenertz ACKNOWLEDGMENT STATE OF WISCONSIN T ) SS. ST. CROIX COUNTY ) Personally came before me this 30th day of October, 1998, the above named Steven B. Goff to me known to be the person who executed the foregoing instrument and acknowledge the same. Pamela A. Skorude, Notary Public" —� •�•'s'` St. Croix County, Wisconsin �Sir, : +1 y My Commission expires: March 17,.2 m r a; THIS INSTRUMENT DRAFTED BY: �:'.'!• t f Steven B.Goff yh••��n�„:•••„ - Bye,Goff&Rohde,Ltd. PO Box 167 River Falls,WI 54022 SBG\LENERTZ\CLAPP\D 1 WD 1) Mr.Stout would like to construct a two family dwelling/side by side duplex on Lot anCZim .26, P.5950 located north of 1-94. 2) Ate VI � We do n ot expect there to be an impact on surrounding properties due to there being very little difference between a lot having a single family residence located on it verses a two family dwelling. 3) Very little difference between a single family dwelling on neighboring lots/parcels and a two family dwelling.Almost directly north of the WISDOT weigh station. 4) There already is mixed use of the surrounding area consisting of residential lots,ag land and the WISDOT weigh station on I- 94. 5) Request does not impact the public health,safety or general welfare any more than the typical construction of a permitted single family dwelling would. 6) The same measures would be taken during construction to minimize the creation of dust,smoke and noise as there would typically be during permitted construction. 7) The plan is to construct a high efficiency two family dwelling which includes 3 bedroom/2 bath,in floor heat and an attached 2 car garage. 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CROIX CO,, WI RECEIVED FOR RECORD BEARINGS ARE REFERENCED TO THE ` 08/15/2013 3-22 PM NORTH LINE OF THE NE114 OF SECTION 3'1 BEARING N89`07'20"W(ST.CROIX z EXEMPT #: z COUNTY COORDINATE SYSTEM), m a REC FEE; 30,00 0 FD COPY FEE: 3.00 UNPLATTED LANDS Z :15 PAGES: 2 m 1 m oNORTH-SOUTH 1/4 LINE � SOO°15'58"W 861.61' r� — ...... .f o m 417.59' Tn !j ► 411.02' • - - - — z 0 Z 444.0 ' 33.00* 828p m r m z �cn u, zO� ro ro y �C C7 p j' k7 (�� /' of O I L \i 0 O o m ��p� 411.02' 33.00' , o a m c m I �{ r" rn n = O n 207,96' 203.06' I( "A Cn m ` �" N00°15158"E 444,02' cm 4p m m i J cn OM o � �Q � � h3 a, � m `° m r . p °y 4,= _•ice co F ri D m Q Q °-w w * n I\] m 7�� •� � o m =1u) w o �, �- - - 0n zni N I�rn C _ 1f ^^ m �. m IC { ® V iCf7 �? m cn s rn I r "C'] m -4 `^� Q a :. cry X m I+ OJ y 3 33' Z Ao 0 � z � 0rn � . z I:z "' 827.96' 1 r VZ! 0 512,96' 245.00' 70.00' I id N {f} NOOW'55"E 860.96' m ► 33.00'- I C11 ��j m / D L1 4 > li ❑ v r\c� ' -.. 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