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042-1085-30-320
1 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 569508 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: Stout, Richard O. &Janet I Warren, Town of 042-1085-30-500 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: /00, 0 / C1 63 f_0 i- ����� 31.29.18.476A90 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic - Benchmark c. � L .�' rvtG't, Aeration Bid .(Sewer i / t Holding St/Ht I t r — 2 TANK SETBACK INFORMATION St/Ht Outlet 7 TANK TO f/L WELL BLDG. Vent t Air Intake ROAD Dt Inlet Septic P Dt Bottom Dosing >f', c, .> eader an.. Aeration rx "t C:b Dist. pe 'L � , /0-7 Holding z' Bot.System q,S ' �') PUMP/SIPHON INFORMATIO �-�1 -AV 1 Final Grade 5 "� m `f, q Manufacturer Demand St Cover GPM Model Number Q'yt im n 4t 2 TDH Lift Friction Los Head TDH Ft � l t ?) Forcemain Le Dia. Dist.to Well SOIL ABSORPTION SYSTEM 2 C % ytit ? 1 CIc BED/TRENCH Width Length No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS t 3o ��__ � SETBACK SYSTEM TO ` P/L V1 BLDG WELL LAKE/STREAM LEACHING Ma�act r 5;, INFORMATION CHAMBER O ✓y T e Of System: y �/ / 1,.. Model Number: �, I PIS TRIBUTION SYSTEM Head '/Manifold "I • - Distribution / ) x Hole Size x Hole Spacing Vent to. it Inta e J �r Pipes) ` s—� Length Dia Length f�L� Dia Spacing <-� — ��f' 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 1 Bed/Trench Center Bed/Trench Edges Topsoil Yes 0 No [ Yes E] No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / ,11 Inspection#2: Location: 957 70th Ave Roberts,WI 54023(NW 1/4 NE 1/4 31 T29N R1 8W) NA Lot 09 Parcel No: 31.29.18.476A90 1.)Alt BM Description 2.)Bldg sewer length -amount of cover= / / Plan revision Required? 0 Yes / Use other side for additional information. SBD-6710(R.3/97) Date Insep4Sq Cert.No. T oil Test a'd System PLOT PLAN PROJECT Roscon Properties 9 ADDRE 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 5/28/14 BEDROOM 6 CONVENTIONAL XXXX IN-GROU 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 1291 # of chambers 64 BENCHMARK V.R.P. Top of survey iron V/ ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 107.1/106.1 4.5' below qrade 3 o 6 Bedroo uplex 25' 03 utt Combo ptiq lank t, 20' 75' B-3 50' B- v� 80' 0, 14% Slope 2-3' X 130' cells with>3' spacing 111' B.M.* 109' B-2 107' All piping shall be SDR 30/34,within 10' Vent of tank,piping shall be Schedule 40. >6„ Quick4 Standard 444' Property Line Scale is 1" = 40' of Cover Leaching Chamber ith 20.0 ft2 of Area ' unless otherwise 1;„- 5wfftA2/pair of end caps noted 4 Long Grade at System Elevation 34" s/zY/2,0/Y _'a�s e--�.� Coo County<-> I 1 /) Industry Services Division c - l ,-c7 1 --A- 1400 E Washington Ave Sanitary Permit Number(to be filled in by Co.) P.O. Box 7162 � Madison,WI 53707-7162 Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary �� �� u ses in accordance with the Privacy Law,s. 15.04(1)(m),Stats. I. Application Informs n—Pleas rint All JInformstion Property Owner's Name Par # ti• ( fl �, t n. Property Owner's Mai mg Address operty Location 3 S I T CL C S' �ry� .Lot City,State Zip Code Ph ( /,, Section 31 irc►e o*---, a'0 —N; RE rW II. ype,,of-Bu' ng(check all that apply) Lot BOA or 2 Family Dwelling—Number of Bedrooms M� Subdivision Name o)_{� ❑Pub]ic/Commercial-Describe Use ❑City of C` CSM Number ❑Village of El State Owned-Describe Use gQg yZ 53 3 6,161 t� r C� /01 Z(o i 5,,:5.6. Town of�c(t/P�n� IIl.Type of Permit: Check only one box n line A. Comple a line B if applicable) A. XAew System ❑ Replacement System ❑Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(explain) B. ❑ Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV._Type of POWTS System/Component/Device: Check all that apply) rr Ta dL �r on-Pressurized in-Ground ❑ Pressurized in-Ground ❑At-Grade ❑Mound>24 in.of suitable soil El Mound<24 in.of suitable soil��A Q� ✓5 ❑ Holding Tank ❑Other Dispersal Component(explain) etreatment Device(explain) V.Dis ersal/Treat ntArea Information: .A s�' t Design Flow(gpd) Design Soil Application e(gpdsf) Dispersal Area Required(s tspersal Area Proposed( System El vation is /3 3� 7,3,6/93, 91- VI.Tank Info Capacity in otal #of Manufacturer Gallons Gallons Units n v $ y Y New Tanks Existing Tanks (�, o 1� ✓ I a.U in y cn ii C7 6. Septic or Holding Tank 2oun L CAAtf X, Dosing Chamber VII.Responsibility Statement—I,the undersigned,ass responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plum gnature MP/MPRS Number Business Phone Number Plumber's Address(Street,City,State,Zip Cod V111.County/De artment Use Only Approved Disapprov Permit Fee Date Issue Issuin gent Signature wrier Given Reason for Denial $ r IX.Conditft$T M" easons for Disapproval 1; Septic tank,effluent filter and dispersal cell must all be services/maintained as per management plan provided by plumber. 2. All setback requirements tpust..be,maintalAW as per aWicable code/ofdinanb�. Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size 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 9 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 Specifications She 8-10. Soil Test Signature License number#226900 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 )00X 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 4" wood fence post ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE WELL Same as Benchmark O *H.R.P. SYSTEM ELEVATION 93.8/93.6/93.4 4.5' below qrade 70th Ave 18' B.M.* B-2 150' 60' Al 20 3-3' X 90' cells with>3' spacing -1 0' A additional boring is to be done at time of installation to expand 50' tested area B-3 0 Huffcutt Combo Tank Pro 6 40' 40' Bedroom duplex Vents 444' Property Line 212' P.L. All piping shall be SDR 30/34,within 10' of tank,piping shall be Schedule 40. Vent A4n Quick4 Standard Scale is 1" 40' Leaching Chamber with 20.0 ft2 of Area unless otherwise 2„ �5.6ftA2/pair of end caps noted 34" Grade at System Elevation 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 98.0' t Grade Vent 4„ 4, i�30/34 Septic Tank ,jV,en 5' 4' Long 1 3 4 Grade at System Elevation 3499 Grade at System Elevation 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-93.8 B93.6 22 chambers per cell C--93.4 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer S r Mailing Address Property Address �5 7 {Verification required from Planning&Zoning Department for new construction.) City/State _ Parcel Identification Nuvaber LEGAL DESCRIPTION r Property Location 1/4 , %4 , Sec;.3 , T_e�N R j J.W, Town of Llq l/0.�✓ — Subdivision , Lot#�. Certified Survey Map#_ , Volume ,Page# Warranty Deed# _ Vo[tune , Page# Spec house 61 no lot liner, identifiable GD 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 wasi:e 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:hg 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. Uwe,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 Departrr.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 is form are true to the best of my/our knowledge. I/we am/are the owner(s)of the property described above,by virtue of a rranty deed recorded in Register of Demis Office. Number of bedrooms SIGNATURE OF APPLICANT(S) l DAT ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV.08/05) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of-�_ FILE INFORMATION SYSTEM SPECIFICATIONS Owner n r Septic Tank Capacity -_ ��s7� 7j� a! ❑ NA Permit# _ Septic Tar k Manufactui er — Effluent Filter Manufacturer_ --_0 NA DESIGN PARAMETERS --- - ❑ NA Effluent Filter Model ❑ NA Number of Bedrooms __ _ ---- ---------------- -- NA Pump Tank Capacity ANA Number of Public Facility Units _�_Estimated flow(av erage) � alJda Pump Tank Manufacturer _Pump Manufacturer Design flow(peak),(Estimated x 1.5) al/ z Pump Model S ' Application Rave gal/day/ftMonthly avera e" Pretreatment Unit Standard Influent/Effluent Quality 9 Fats,Oil&Grease (FOG) <30 mg/L ❑Sand/Gavel Filter' L1 Peat Filter Biochemical Oxygen Demand (BODs) s220 mg/L ❑NA ❑ Mecharical Aeration ❑Wetland Total Suspended Solids (TSS) .<-150 m_g/L ❑ Disinfection�-— -11 Other: -- Pretreated Effluent Quality Monthly average Dispersal Gell(s) tJ NA Biochemical Oxygen Demand (BODs) 530 mg/L In-Ground(gravity) D In-Ground{pressurized) Total Suspended Solids (TSS) 1530 mg/l. �A ❑At-Graae ❑Mound Fecal Coliform(geometric mean) 5104 cfu/100m1 - ❑Drip-Line _ - ❑Other 0 NA Maximum Effluent Particle Size X in dia. ❑ NA ort;e�-__ --A Other. -- --- -.._ ------— __-__ _ NA Other: NA °Values typical for doNnestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Service Event Service Frequency 13 month's) (Maximum 3 years) ❑ NA Inspect condition of tank(s) At least once every: Pump out contents of tank(s) When combined sludge and scum equals one-thief(Ya)of tank volume - _- 0 NA - ----- ---- � Inspect dispersal cell months s) (Maximum 3 years) ❑ NA s) - At least once every: _ r(s ---- - ----- -- — ---- monthi s) ❑ NA Clean effluent filter At least once every -- L ear(s; ❑month)s) NA Inspect pump,pump controls&alarm At least once every: ` ❑year(s; �--- - ❑monthi s) NA Flush laterals and pressure test At least once every: O years)_- monthi s} NA At least once every_- - - - p year(s) -Other`------------- NA MAINTENANCE INSTRUCTIONS inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer;POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s)to identify any missing or broken hardware, identify any cr-.Icks 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(s) shall be visually inspected to check the effluent levels in the observation pipes and to chect: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 fifters, mecharical or pressurized components, pretreatment units, and any servicing at intervals of 512 months,shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of an,,service event. Page—_of START UP-AND OPERATION For new construction, prior to use of the POW1 S'check treatment tanks) for the presence of painting products or other chemicals that may impede the treatment process and/or darrage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s)removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill 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. e avoid this sir contact aa contents of thia POWTS pump assist inymanually Servicing Ooerator prior to the u p controls to)restore normal levels effluent pump or within the pump tank. Do not drive or park vehicles over tanks and dispersal ceps. 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 ss di apce and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scrap:; medications; oil; painting products; pesticides;sanitary napkins-,tampons;and water softener brine. ABANDONMENT When the POWTS fails andlor 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: 0 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 Septagf:Servicing Operator. * After pumping, all tanks and pits shall be excavated and removed or their cover's 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: CI A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure,lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. A suitable replacement area is not aysailable due to setback and/or soil limitations. Baring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. he site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation X T n 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 POW fS. D Mound and at-grade soil absorption systems may be reconstructed in place following nimoval of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. «WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATIIAENT TANK UNDER ANY CIRCUMSTANCES. DP-ATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS __ — -- -- -- te ill Zo 'POWTS INSTALLE n S &W,$MAINTAIN R Name CGS Name _ v' /3/ 1�� -- Phone �J���Z �' Phone 212-- SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AU 'HORITY /,._, � Name –-Name Phone J-, 7 Phone / This document was drafted in compliance with chapterl3PS 383.22(2)(b)(1)(d)&(f)and 383.54(1),(2)&(3),Wisconsin Administrative Code. 'ILTEn CARTIUDGE INSTRUCTIONS cu""Kao the&W Of 9111 111litlilat Wpol to ansoare it i, tw►Nowd WWW ti►e aoac 006"Ing. v tow,%" olum 010A into the task through the oWhot or onalvaid:www Web)j6d 6016 pipe. dwltzloftlplot Wdu the uutm �rvrp a Wtdk on can Is am try ftftW utl the Outlet Plod,lylWas"ar"tivw 11wriva of 41►-W&solpe needed to beam the ijbionor to the tw*and Wap it iltalno the "'Phol g116 suPP"i"If side 5111111111111:14"Whad hi wt utilind, procund to aW fmw. :'Yvp 3 For km"NsUalos ao"W"a""M uPtkftl SUPPlublental side sinaixort- sak'"A""M adw%'- ►ah pllret P"i"a ttm Mthr cam. If aside support hieW it;ivjA umized,lWofted to dup four. Solvent Weld the 11111:61 case Alto the atstlad:phan. Ituiert the Mter cwtddgw into the rasa, lalivosinq duft UUM the MWe IO&E,itotia the b"ttL",1 W the c"". If it VRS sWW1 b;uWkftd: ilm"t bAv tim Wto'and kick by turning do"ifie W. 1. 'the effluent 11RUA,Awould IM dalliftw WIVIRIT tf$ft the AAWAIC rank 2. OWI the Oiltlat Mac"A QP*hllau to Instled OW twit akid War 31. PLAMP the septic think ftWkhV curs to ruviwe the audolij loiVer an the botbont of the oink 41rd"Ot Ault the"'toirr and offluvilt, 4. once Had,aftlan",love#has basso towered bulaw the rowan of tlju czidlot pipe,ffnvdy pWA up"k the filter hboadle to dislodge the curbidge"to t6 coarvilt. w. 5- Slide the rS"00 40 and ot le Of bill OWN*W d4kWho. 6, v VAs switch vorvioloonizd to alb Wiart"4"ad,the SWfth 4,'oulld be nownwied by tor"inq r4uargoorduckalviou 900 kind aim ued wikh waiter ounly. 7. ftft hWdMg the cwrtriilgia my fts"(largo,not wvf4cu fatAl►u down)over dw amu"awansh1%whom ON the uAdrWou With WAlle vAY,making'sum afi-Piago.44441017001 Is dv"d back Into the tarak. & If V"wwfth is ubumd,iv*co by limumba into fitter Md U,Mi►o jiuciavilift aura. n. 9. 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Rac'4 fMr il�jsorM Return Address: OCT 3 Q 1998 �� sS✓z- a:30 Re far et Deeds Parcel I.D.Number IPINI: 042-1086-10;042-1086-20;042-1086-40:042-1085-50, 042-1086-80:042-1085-40;042-1086-20;020-1108-60: 020-1108-60;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 ) I 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. v/ /7• SJ�1a� { fi W. Pamela A. Skorude, Notary Publie- —W fJ C, St. Croix County, Wisconsin �.�: ?"„ My Commission expires: March 17,.,,:t(s' "s a: iMls'�? tv - THIS INSTRUMENT DRAFTED BY: a••� � r Steven B.Goff t Bye,Goff&Rohde,Ltd. ',',"•,a.�„ •, PO Box 167 River Falls,WI 54022 SBG\LENERTZ\CLAPP\D 1 WD T. f,../ "► ` Land Use ST. Planning&Land Information Resource Management Community Development Department November 22, 2013 File Ref. #SE88072 Richard Stout 1353 Awatukee Trail Hudson,WI 54016 RE: Lots 8 &9 of CSM V. 26/P. 5950 in NW '/4 of the NE '/4 of Section 31, T29N, R18W, Town of Warren Dear Mr. Stout: The St.Croix County Board of Adjustment(Board)has reviewed your request for the following item: Special exception for a two-family dwelling pursuant to Section 17.15(6)(a)of the St.Croix County Zoning Ordinance After the hearing on November 21,2013,the Board approved the special exception request with conditions. The enclosed document is the formal decision regarding the application. You must obtain any other required local,state,and federal permits and approvals. Feel free to contact me with any questions or concerns. Sincerely, Pamela Quinn Land Use Specialist Enclosures: Formal Decision cc: Clerk, Town of Warren Phone 715.386.4680 Government Center, 1101 Carmichael Road, Hudson, WI 54016 Fox 715.386.4686 www.sccwi.us/cdd www.facebook.com/stcroixcountywi cdd@co.saint-croix.wi.us J Wisconsin Department of Commerce SOI E TION REPORT Page--L of-3— Division of Safety and Buildings in accordance with Comm 8 is. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. n mu include,but not limited to:vertical and horizontal reference point(BM),directio nd parcel I.D. percent slope,scale or dimensions,north an- w,an qet�o -ton t road. L-lr � Rev )4A7 Please print al information. Personal informal iqn ou provide may be used r econd o s ri w,s.15. 4(1)(m)). Property Owner O�C �" © Pro rty Location iL{Ilfc S v ST.CROIX COUNTy Govj Lot /&rt L 1 14,(j 1/4 S T Z N R / E(or Property Owner's Mailing Address Lot # Su a or cx �e 5 ity State Zip Code Phone Number (`,4 ❑Ci Villa (Town Barest Road ) a �u ( New Construction Use:ij?P Residential/Number of bedrooms :3-41_ Code derived design flow rate L/ r O GPD ❑Replacement ❑ Public or commercial-Describe: Parent material ��tt4 r�SGL Flood lain elevation if applicable Q1/ ft. General comments 5{2 e U 41,Z ' and recommendations: 5 Y �L�L Yb O 1t r 5� Boring# Fj Boring r ® Pit Ground surface elev.L77;30 ft. Depth to limiting factor 1 o 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 I -Eff#2 C' 2 r 3 S C 5 2 i Z-� 1() r Y/41 S�` 2 M r i Zv / -- S o s rm( , 1 t V 5d ® Boring# �❑7 Boring �Z.s t?9 pit Ground surface elev. O 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 0-I(r i /31 m r` v z 1 10 /y — 5.�c r•»S r C 5 3 3-� o14 — 5 I f s1 Effluent#1=BOD >30 1220 mg/L and TSS>30<150 mg/L 'Effluent#2=BOD <30 mg/L and TSS<30 mg/L CST Nam(Please Prin) re CST Number Addree/sss Date Eva�l/uation Conducted Telephone Number ' I t1lX C l.cJ (` "/0/; 7-2-5--o?- 7/.S-,76,o C7e Property Owner Parcel ID# C a T Page _ of N Boring# ❑ Boring' � �� pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Bate Horizon Depth Dominant Color Redox,Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu.Sz. Cont.Color / Gr.Sz.Sh. f f 'Eff#1 'Eff#2 5- o r c 5` .ti v hd ❑ Boring# ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil 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#1 'Eff#2 Q 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=BOD5>30<220 mg/L and TSS>30<150 mgA- '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 608-264-8777. SBW330(R.d00) Property Owner 5� Parcel ID# t �Q T Page _ of Z F31 Boring# E] Boring' - T pit Ground surface elev.ff 16 ft. Depth to limiting factor 12- in. -So�ilApplication 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 .ti t %* hb 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 GPDAf in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 '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.Si Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 Effluent#1 =BODS>30 1220 mg/L and TSS>30<150 mg/L 'Effluent#2=BOD.,130 mg/L and TSS 130 mg/L The Department of Commerce is an equal opportunity service provider and employer. 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Revie d by Date Personal inform i you provide y be*fed r seco ur os s(AfLi @chi Law,s. 5.04(1)(m)). 4 Property Owner O � \ -E� IJ IJ/ P perty Location ` ST.CROIX COUNTY G A.Lot 114 i(r —114 S T N R E(or 4(1 (� 4- w c �/ ! Property Owner's Mailing Add ess t# BIo # ;Subd. N or CSM# NQ - GU �T City State Zip Code Phone Number ❑City --❑Villag To earest Road 4 70 New Construction User Residential/Number of bedrooms Y Code derived ddsign flow rate 0 d GPD ❑Replacement ❑ Public or commercial-Describe: _________________—._ _—__..___.— __ Parent material L 61;51�1 Flood Plain elevation if applicable General comments / y/ r and recommendations: .5y-S/-e,-,x r e-"eV` V-0 VY -)Co lr J/Lt 2-4 13 (Z- � a Boring# Boring — G pit Ground surface elev. 96 y ft. Depth to limiting factor�_in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPOM in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. / 'Eff#1 I 'Eff#2 1 ro z Z iZ- 0 loqf ! SSG 9e,-S vn-G- CS — ® e— Boring# El Boring R Pit Ground surface elev. .20 ft. Depth to limiting factor 3 a in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f? in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 •Eff#2 Y 5� eSL sbk 6 5 40 N5-iU o yo `� l• Z Effluent#1 =BOD >30 1220 mg/L and TSS>30<150 mg/L 'Effluent#2=BOD <30 mg/1--and TSS<30 mg/L CST Name(Please Print) Sign CST Number � ZS3� Address Date Evaluation Conducted Telephone Number 71S-- 76 0 _ f,► 7 4 4:- A Property Owner '>f 0"Jr- Parcel ID# r a� Page Z of ® Boring# ❑ Boring a Pit Ground surface elev. !�i o d ft. Depth to limiting factor t Z`� in. Soil Application Bate 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 V3 51Y Vi 7- t ❑ 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/fg in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 4 ❑ Boring Q Boring# Ground surface elev. ft. Depth to limiting factor in ❑ pit 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 =BOD5>30<220 mg/L and TSS>30<150 mg/L Effluent#2=BOD,<30 mg/L 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. SBD4330tRAM) Property Owner J-6c Parcel ID# �a Page Z of 5s] Boring# Pit g Ground surface elev. , d - 9 Soil Boring J<i 0 ft. Depth to limiting factor �n• Application Rate Horizon. Depth Dominant Color Redox`Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. f 'Eff#1 'Eff#2 56 sl c5 -- 40 s z _ C> CAA t 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 Q Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 •Effluent#1=BODS>30<220 mg/L and TSS>30<150 mg/L Effluent#2=BODS 130 mg/L 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 tR.M) *4 1PTI N 3h /� ! T 2 N R/ O NA LL�TM T S T e 6ALES I» s V HM I ELEVATION BM 1 DESCRIPTION i p of -!L6jorjr1 �^ ° SM a ELEVATION IQQ<0 _--- eM a DESCRIPTION � o - SYSTEM ELZVATJOF4 SYSTEM TYPE Gn 6-3 Z 96 SIGNATURE - DATE ' 1) Mr.Stout would like to construct a two family dwelling/side by side duplex on Lot 8 and Lot 9 of C.S.M.V.26, P.5950 located north of 1-94. 2) We do not 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.