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HomeMy WebLinkAbout030-1075-60-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 569557 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: Weyer, Christopher J. St. Joseph, Town of 030-1075-60-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: c" /'GE C, , �.. c / I S f-� h ° ILI-2-'J �,A e 27.30.19.2636 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER 7 13 ACITY STATION BS HI FS ELEV. Septic J�y), �,' t; / Birphmark. �c� 'J` G Alt.BM _- +v } tiGt ic. Z D l i l? i ytX L'v' Z , Aeration BldgSewer Holding S Ht Inlet �( SthHt Outlet - v {'1x - .`� �'I e17 TANK SETBACK INFORMATION TANK TO L WELL BLDG. Vent to Intake ROAD tIn]et -��� � � �„ 7, v Septic ft jl r l v 'ti(. Boitall� C � �t I io .Z� G��v- Header Man. c osing y C) ( (.oa_; 4A �c '�4 }�t, 7.1 5 1 Z 7 Aera n Dist. 'pe Y G i j�' Holding � I Bot.System1 ,Z L Cl V Final Grade PUMP/SIPHbN INFORMATION G(IVIlk ,' 'i:5 (� �'�" `1 �' Manufacturer DeP^and St Cover 2 J y}� .Z 61 Model Number TDH Lift Friction Loss em Head TDH Ft Forcemain Length D Dist.bVell SOIL ABSORPTION SYSTEM ZZ- C- t BED/TRENCH Width ^�f Length, No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS / 1 , SETBACK SYSTEM TO P/L BLDG WELL LAK EAM LEACHI G Manufacture,L INFORMATION (CHAMBER O TypR Of System: + \ _UNI Model Number: DISTRIBUTION SYSTEM Hole Size V -� Air Intake e Distribution x Hole Spacing Dia Pipe(s) Length Dia Spacing Length J R t 1� 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 Bedli'rench Center Bed/Trench Edges Topsoil DE Yes 0 No Yes [ No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: ) / / �r�lnspection#2: Location: 1351 Cty.Rd. I SOMERSET,WI 54025(SE 1/4 NE 1/4 27 T30N R19W) NA Lot 1 Parcel No: 27.30.19.263B 1.)Alt BM Description 2.)Bldg sewer length= -amount of cover= d I Plan revision Required? F27 Yes &No I � Use other side for additional information. L— J Date Insepctor's Sig r Cert.No. SBD-6710(R.3/97) PLOT PLAN PROJECT Chris Wever ADDRESS 1351 Ctv Rd I Somerset Wi 54025 SE 1/4 NE 1/4S 27 /T 30 N/R 19 W TOWN St. Joseph COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE 5/8/14 BEDROOM 4 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000/280 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE ABSORPTION AREA 890 # of chambers 44 BENCHMARK V.R.P. Top of septic tank cover ASSUME ELEVATION 100° Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark All piping shall be SDR 30/34,within 10' SYSTEM ELEVATION 94.0/93.0 5' below qrade of tank,piping shall be Schedule 40. Vent >6„ Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps ,Well 4' Long 12 Existing 4 Grade at System Elevation bedroom AL 34" House 25' 45' 35' 20' Scale is 1" = 40' B.M. ' v unless otherwise DW to be pumped and buried �� 1 '�. ti , ` � r N noted � P 2 S�S 383.33 15' 4 I V ,��Lr✓W� B-1 ,�, s' B-3 85' 14% Slope 2-3' X 90' cells with>3' spacing 15' l' B-2 50' 96.5' 98.5' Cty Rd I 391' Property Line 120' TT dr'" nr i I county I Safety and Buildings Division ��. t) l� ► "' a'"" 'Z01 W.Washington Ave.,P.O.Box 7152 Sanitary Permit Number(to be fined in by Co.) Madison,Wl 53707-7162 _ MAY d 8 70 a � s implication State Tra on,Nu In accordance with SPS ,submission of this form to the appropriate governmental unit /J is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Addres if diff=w than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law,s.15. 1 m Stats. L Application Information-Please Print All Information Property Owner's Name Parcel# Property Owner's Mailing Address Property Location •2-(o 3 1 S Cov<Lot a / J City,State Zip Code Phone Number S yy_ME yy Section So f ) cock T�N; R� orW II.Type of Building(check all that apply) Lot# 2 Family Dwelling-Number of Bedrooms Subdivision Name Block# "- ❑Public/Commercial-Describe Use ❑City of ❑State Owned-Describe Use CSM Number ❑Village of �!y Town of III.Type of Permit: (Check z on line A mplete line B if applicabl A. ❑New System replacement System ❑T olding Tank Replacement Only ❑Other Modification to Existing System(explain) B• ❑Permit Renewal ❑Permrt evision ❑Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner t)n kn QW,,l IV.Type of POWTS S stem/Com onent/Device: Check all that apply) Non-Pressuized In-Ground ❑Pressurized 1 n-G r o u n d ❑At-Grade ❑M o u n d 2:24 in.of suitable soil y 24 1�r of suitable 11 Holding Tank 11 Otber Dispersal Component(explain) %S �L et a (exp am h V.Dispersanreatment Area Information: Design Flow(gpd) Design Soil Applicati Rate(gpdsf) Dispersal Area Required(st) Dis Area Proposed(fit) t7 6 DL 7 s e 190 � 9y�� 3. v VL Tank Info Capacity Gallons in Gallons U Of n���ma, New Turks Existing Taalm ��/Z�r Septic or Bolding Tank O vriD Dosing Chamber VII.Responsibility Statement-1,the andtrsigoed,assuA responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber' S' MP/MPRS Number Business Phone Number ZK Z70 �LW Plumber's Address(Street City,State,Zip Code) VIII. un /De artment Use Only Approved ❑Disapproved Permit Fee OV Date Issued suing Agent ign • ❑Owner Given Reason for Denial S / 7S-.i ' O � IX,CSQ �go�� rovaVReasons for Disapproval - 3f3- 33 1.Septic tank,effluent filter and ` dispersal cell must be serviced/maintained as per management plan provided by plumber. 6 Ca! C Y'(�/��► y" TJ`' 2.All setback requirements must be maintained et 4L4 as per applicable C for the system and submit to the corn only Wpaw not I&tban g W x 11 inches in size SBD-6398(R. 11111) Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 5/8/14 Owner: Chris Weyer Location: SE 1/4 NE 1/4 S27 T30 N,R19W 1351 Cty Rd I St. Joseph 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 Sheet 8-10. Soil Test 11. Utilization of a existi septic tank form Signature License num r#226900 PLOT PLAN PROJECT Chris Wever ADDRESS 1351 Ctv Rd I Somerset Wi 54025 SE 1/4 NE 1/4s 27 /T 30 N/R 19 W TOWN St. Joseph COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE 5/8/14 BEDROOM 4 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000/280 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE ABSORPTION AREA 890 # of chambers 44 BENCHMARK V.R.P. Top of septic tank cover ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark All piping shall be SDR 30/34,within 10' SYSTEM ELEVATION 94.0/93.0 5' below qrade of tank,piping shall be Schedule 40. Vent A Quick4 Standard Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps ,Well Existing 4 34" Grade at System Elevation bedroom House 25' 45' 35' 20' B.M.* Scale is 1" = 40' DW to be pumped and buried T 1ST unless otherwise noted Pe r S PS 383.33 15' 30' B-1 5' B-3 85' 14% Slope 2-3' X 90' cells with>3' spacing 15' B-2 50' 96.5' 98.5' Cty Rd I 391' Property Line L 120' Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber To be >i' above rade 5.6ft^2 pair of end plates g Finish grade elevation Typical Installation 99.0' Vent ACI Grade Vent 3, 4„ 3, X30/34 Septic Tank 5' Long 193 5' S' Long 1 Grade at System Elevation 3659 Grade at System Elevation Spacing 5' 2-3' X 92 ' Cells Same on other end Observation tubeNent At end of cell A B 22 chambers per cell System elevations: A-94.0' B 93.0' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner /► f l mit Tank Manufacturer:�aty/►���,�� Kosf ❑ NA Per # C/ &G' 5 Septic ❑Dose ❑ Holding Volum ®' (gal) DESIGN PARAMETERS Tank nufacturer: 1� � ❑ NA Number of Bedrooms: 7A3RWA Septic ❑ Dose ❑ Holding Volume: ZYO (gal) Number of Public Facility Units: Vertical Distance Tank Bottom(s)to Service Pad: (ft) Estimated(average)Flow: (gal/day) Horizontal Distance Tank(s)to Service Pad: (ft) Speck servicing mechanics must be provided H vertical is>15 feet or Design(peak)Flow=(estimated x 1.5): 600 (gal/day) If horizontal is>150 feet. Specific Instructions to be provided on back. In Situ Sal Application Rate: (gauday/ftz) Effluent Filter Manufacturer ❑ NA Standard(Domestic)Influent/Effluent Monthly average.. Effluent Filter Model: Fats,Oil&Grease (FOG) 530•mg/L Pump Manufacturer: NA Biochemical Oxygen Demand (BOOS) 5220 mg/L ❑ NA Total Suspended Solids(TSS) 5150 mg/L Pump Model: . High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 mg/L Manufacturer. _, NA (BODO >220 mg/L NA ❑Mechanical Aeration ❑Peat Filter SS) >150 mg/L ❑Disinfection ❑Weiland Pretreated Effluent Monthly average ❑Sand/Gravel Filter ❑Other. (BODE) 530 mg/L Soil Absorption System Fecal Coliform( eometric mean) s10`m ❑ NA Ground(gravity) ❑In-Ground(pressure) [01 NA ❑At-Grade ❑Mound Maximum Effluent Particle Size 1/6 in dia. ❑ NA ❑Drip-Line ❑Other: Other: NA Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) When combined sludge and scum equals one-third(Y3)of tank volume ❑When the high water alarm is activated Inspect condition of tank s) •At least once eve month(s) (Maximum 3 years) ❑ NA p ( every: c,.S earls) Inspect dispersal cell(s) At least once every: nth(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: l ❑ earth(s) ❑ NA Inspect pump,pump controls&alarm At least once every: 0.Y h(s) ❑ NA Flush laterals and pressure test At least once every:. ❑month(s) ❑ NA ❑years) Other At least once every: [I months) [I NA . ❑year(s) other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper). 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 a check for any back up or ponding of effluent on the ground surface. The soil absorption system shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any treatment tank equals one-third (%)or more of the tank volume,the entire contents of the tank shall be removed by a Septage Servicing Operator(pumper)and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code: Ali other services, including but not limited to the servicing of effluent filters,mechanical or pressurized components, pretreatment units, and any servicing at intervals of<_12 months,shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. GMW-005(02/05) Page of START UP AND OPERATION .the POWTS check treatment tank(s) for the presence of painting products, solvents or other For new construction, prior to use of chemicals or sediment that may impede the treatment process and/or damage'the soil absorption system. If high concentrations are detected have the contents of the tank(s)removed by a Septage Servicing Operator(pumper)prior to use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is not recommended,as the excess wastewater will be4scharged to the soil absorption system in one large dose causing an overload that may result in the backup or surface discharge of effluent,and damage to the system. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator(pumper)priorto-restoring power to-the pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Do not drive or park vehicles over tanks or the soil absorption system. 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 treatment tanks and soil absorption system: acids, antibiotics, baby wipes,-cigarettatutts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drain(sump pump)discharge,fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps,medications,oils,painting products, pesticides,sans V napkins,solvents,tampons;and water softener brine discharge. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shell be taken to insure that the system is properly and safely abandoned in compliance with s.Comm 83.33,Wisconsin Administrative Code`.: • All piping to tanks,pits and other soil absorption systems 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(pumper). • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by red 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 the time of their permit issuance. A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology,a holding tank may be installed as a last resort. ❑ 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 maybe installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE.. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE. ADDITIONAL INSTRUCTIONS: POWTS INSTALLER POWTS MAINTAINER. Name Name Phone J" �J.— Phone 7 SEPTAGE SERVICING OPERATOR(PUMPER) LOCAL REGULATORY AUTHORITY Name ��_,__ Name �O/}�241_,4 Phone _ Phone 3 This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections Comm 83.22(2)(b)(1)(d)8(f)and 83.54(1),(2)&(3),Wisconsin Administrative Code. SNOIIVOOSSV 3138ONOD 15VO38d WSNOOSIM V 1VNOaVN g v� z7'}7n7,}dny'MMM ■ jjjL-EZL (SID XV! 3 U� •313 U 3 U 0 3 NNdl '31133 H 80 :30 a38YUM 9191 426 (008) 9 9441-62L (SIL) NoHdIS 'Jlld3s 'dwnd 6 0Nn0a - N dB 082 c ' 1❑3'O dd1NVld 03Li11838 y OWN Is p-AE21 179117 -------------------- I Z O ¢ W 1 �fPbd �P 0'� w o W •b��2 �m U W N J w3 I z� Qo Z Q "w'' '�i W U LL, h H LLJ za Y = -iPav < a Z ~ v v ¢ (U L. Q --—————— —————J W F] Y W ¢> a Q O U O I!1Q Q� zV) W M Q ~U W:w N Q Q � K In ,z ,i = J o ,4 0 u °W Z U U M Z v Q q 3 Y 0 ° .6 .6E > A A G J J ^ 2 0� i0 .Z. v W 1Q7 l¢7 � O N N (U LLJ OD c J G Y� N N Z O A A G N II II II V W Q> v -+ zo v un >> �o uaa� d a u� ¢¢Lj U O 117 U U LLJ •E Q d ¢ A F-U W .SL'4 a U ¢ 3 W v Ua uo .o Q J X J (4 z Q ��J U) CL v I � O ~ W Q a (7 W J >0 u > .SL' z_ w V) r O 3 wO ~ U d 0 v Ww w w as C3 a¢ > o z o a U o Q :c_ F o ,84 aQ 3ww N Li W Q w z z .w. z h ° o w� zD J W W U Q y QU ZO A 0 ZJ ¢ Q JW FOO Lo ZW AU m W Zu U 0 H ¢Z fU 30 i •a►HBt� TER CARTPJDGE INSTRUCTION" Installation STEP i pry fit the taker case onto the and Of the outlet pipe to ensure it is centered under the access opening. If not,then either insert more pipe into the tank through the outlet or solvent weld(glue)additional pipe onto the outlet pipe. STEP 2 While the case is still dry fitted on the outlet pipe,measure the length of 8&-inch pipe needed to brace the filter to the tank and wall if utilizing the optional supplemental side support.If side support method.is not utilized, proceed to step four. 5-'Er P.3 For installations uti iZing the optional supplemental side support: solvent weld the IA-inch pipe onto the filter case. If side support method is not utilized,proceed to step four, - Solvent weld the filter case onto the outlet pipe. Insert the filter cartridge into the case, pressing down until the filter locks into the bottom of r. " the case. If a VRS switch is utilized:insert into the filter and lode by turning j•%�"�� r'� clockwise 900. .l�.S• ;'l. Maintenance 1. The effluent filter should be cleaned every time the septic tank is serviced. 2. Open the outlet access opening to inspect the tank and filter 3. Pump the septic tank completely,making sure to remove the sludge " layer on the bottom of the tank and not just the scum and effluent. 4. Once the effluent level has been lowered below the invert of the outlet pipe,firmly pull up on the fitter handle to dislodge the cartridge from the case. S. Slide the cartridge up and out of the case for cleaning. 6. If a Vi2S switch connected to an alarm is present,the switch should be removed by turning counterclockwise go*and cleaned a;f a ••s` with water only. y 7. While holding the cartridge on its side(large fiat surface facing h down) over the access opening,rinse off the cartridge with water I,.. only,making sure all septage material Is rinsed back into the tank. 8. If VRS switch is utilized,replace by inserting into filter and r turning clockwise 90•. sX� 9. Insert the filter cartridge back into the case,pressing down until r. +:''' the filter locks into the bottom of the case. Wit. o� 6 10.Replace and secure the access opening on the tank. 8P l:',.:IV i,"_r-•'rli"}S:4%:1'Yt_TH,eC rlti rr•9 C..••:PrS!'<d`:X:,y;f•�,t}:"'. www;beaniaMte.aom 877-MLFILTERS(653-4583) �2 •-•r Z- ST. CROIX COUNT''' SEPTIC TANK MAINTENANCE Y�GREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer. C411- Mailing Address Property Address (Verification required from Planning&Zoning Department for new construction.) - — J�'9��e�i — City/State Parcel Identification Nut lber ' :/ 0S'`''' LEGAL DESCRIPTION / Property Location 54 v, , �= '/4 , SeC4 7 , T 30 N R /n W, Town of 6/ A0S Subdivision !� 77 , Lot# Certified Survey Map#_ , Volume— 2—3 ,Page# C y Warranty Deed# , Volume ,Page# / Spec house yes no Lot line;: identifrabl 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,ii'needed,by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system, Owner maintenance responsibilities are specified in§Comm. 83.52(1)and in Chapter 12-St.Croix County Sanitary Ordinance. The property owner agrees to submit to St.Croix County Planning&Zoning Department a certification form,signed by the owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on-site wastewater disposal system is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is less than 1/3 full of sludge. I/we,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth,herein,as set by the Department of Commerce and the Departrrient 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 am/are the owner(s)of the property described above,by virtue of a warranty deed recorded in Register of Deeds Office. Number bedroo SI OF APPLICAN'T(S) DA ***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) ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify xfy that i ha ve i ns ec ted the septic tank presently the i re sidence locates Sect on 02 T �" i U on �I 'R� W, Town ref i p inspection, I certify that I have found the tank and baffles to be in good condition functioning properly. and it appears to be i,ast time serviced: l� a o/ -'�- flow back occur from absorption system? Yes No (If . no, skip next Line) APPraximate volume or length Of time: ---- gallons Construction: Prefab Concrete �_ Steel �� Other t'lallufacturer: (If known Age of Ta (If known y: . (S ure) (Name) Please print (Lzcense ---------�- l=)�:��t e Porm to be completed by licensed plumber s, Statutes} or Licensed Disposer (NR 113 Wisconsin Cade} Administrative Plumber (applying for sanitary permit) Certification: — _ V _ In accepting the above statement regardin existing septic tank condition, I certify that the tank to the b conform to the requirements of ILHR 83 Wi ©f my knowledge will inspection openin ver outlet baffle), Adm. Code (except for Name 4-� � liC' Z M///�) Signature MPjMpRg __ L� [J Property Owner_ Parcel ID# Page of FOng# ❑ Boring &Pit Ground surface elev. 22, 0 ft. Depth to limiting factor A9� 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 2 _ 5 v—> i ' a Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 'Eff#2 Boring# E] Boring F-1 ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication 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 =BODS>30<220 mg/L and TSS>30<150 mg/_ •Effluent#2=BODS<30 mg/_and TSS 130 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 altemate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SOD-8330(8.60)) RECEIVED Y merce Mpy nSQOIIL(�EdVALUATION REPORT Page of Division of Safety and Buildings in accordkl�with BoMrfiW Wis. Adm. Code Attach complete site plan on paper not less th$ij$ORO i6*61thTs'('ie.Plan must County include,but not limited to:vertical and hC1 � /LLAfI °n and Parcel I.D. /� percent slope,scale or dimensions,nortfi arrow,and location and distance to nearest road. (/ 3,0- /0 75- &0-'�� Please print all information. viewed b Date Personal information you provide may be used for secondary purposes(Privacy law,s.15.04(1)(m)). Property Owner Property Location j � Govt.LOK� 1/4 1/4 'T N R E( W Property Owner's Mailing Addr ss Lot# Block# Subd. Name or CSM# S City Stat6 Zip Code Phone Number ❑City ❑Village 'Town Nearest Road ❑ New Construction Use)*Residential/Number of bedrooms Code derived design flow rate GPD Replacement ❑ Publi r commercial-Describe: Parent material Flood Plain elevation if applicable lt- ft. General oomments and recommendations: f System Type System Elevation = C/ Fil Boring# [] Boring � 1Z 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 0- Z �1 a V0 z7o, Boring# a 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 10,131-'L s- 7 Effluent#1 =SOD >30<220 mg/L and TSS>30<150 'Effluent#2=BOD <30 mg/L 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 54 0 � 715-246-4516 ;Pla Projecf Name Chris Weyer Soil Test Plot h Bird Address 1351 Cty Rd I Somerset Wi 54025 STM #226900 Lot 1 Subdivision --------- Date 517/14 SE 1/4 NE 1/4S 27 T 30 N/1119 W Township St. Joseph Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of ST manhole System Elevation 94.0/93.0 *HRPSame as Benchmark Scale is 1" = 40' unless otherwise noted Existing 4 5'Well bedroom House 25' 45' 35' 20' B.M. T 15' 30' B-1 5' B-3 85' 14% Slope 15' B-2 50' 96.5' 98.5' Cty Rd I Ad 391' Property Line 120' /O STATE BAR OF W15CONSIN FORM 3-1982 ! 6O$536 KATHLEEN H. WALSH it QUIT CLAIM DEED REGISTER OF DEEDS ST. CROIX CO., WI DOCUMENT NO VOL 1449PAGE 42 RECEIVED FOR RECORD Christopher J Weyer and Sandra J. Weyer I+ 08-13-1999 9:30 AN I if OUEXT�C IM DEED T NN i! I CERT COPY FEE: li quit-claims-to Christopher J. Weyer ; COPY FEE: it RECORDING FEE-. 10.00 PAGES: I f the following described real estate in S t, Croix County, I E ii State of Wisconsin: ll THIS SPACE RESERVED FOR RECORDING DATA l NAME AND RETURN ADDRESS Ij !I !i 430-1075-60 � y I PARCEL IDENTIFICATION NUMBER it The South 20 rods of the SEkNE'k, Sec. 27-30N-R19W !� I I. This deed is given pursuant to that certain Divorce Judgment dated August 5, f t 1999 and recorded August 59 1999 as Case No. 98 FA 191. H r. i it ;I I� l This i c homestead property. 1E f (is) XIMM310K j! '! Dated this S day of August 1c�9 I (SEAL) '��r6i' (SEAL) !I IE . chr s top mar J. Weyer ;! '! (SEAL) `�— '`�`�'���s° �v -(SEAL) {I I . Sandra J Weyer Ej �I ICI �I ACKNOWLEDGMENT AUTHENTICATION i 'I j State of Wisconsin, Signature(s) ss, i 3 St Croix Coun[ . j authenticated this day of 19 Personally came before me this day of I� August , 19 99 the at named {� Chri t er J We and Sandra J. !i I' TITLE:MEMBER STATE BAR OF WISCONSIN (If not, authorized by$706.06,Wis.Scats.) to me known to be the persons who executed the foregoing j m a d acknowledge the sa $,e THIS INSTRUMENT WAS DRAFTED BY -y'%O.�P�� Pue f�'/ i Attorney David J. Estreen - 304 Locust St. Hudson WI 540 6 tlRK' tatPublic, S G�� County Wis. f! r' (Signatures may be authenticated or acknowledged. Bpt nOSliEl. commission is permanent (If n t, state xpiratio�n_da[e} necessary) j5�'•`� •Names of persons signing in any capacity should by typed or printed below Ihetr sigktturtL--. STATE BAR OF WISCONSIN Wisconsin Legal BIeMt Co InC QUIT CLAIM I)EED For No.3—1982 MNwaukee.Wls li , m _ I!IlIILIIIII Illll VIII IIlf I IIII!1111111111 Illf NII 880098 KATHLEEN H. WALSH x REGISTER OF DEEDS o m �, •�, ST. CROIX CO., WI 0 �n a BEARINGS ARE REFERENCED TO THE ST. RECEIVED FOR RECORD °J c z z O CROIX COUNTY COORDINATE SYSTEM 08/15/2008 08:OOAM CERTIFIED SURVEY MAP z m MHPR,,%VV12D Ra nMD� VOL: 23 PAGE: 5553 n R, a ------- ------ REC FEE: 13.00 m C.T.H. n'/o PAGES: 2 m - m m WEST LINE OF THE SE1/4 OF THE NE-1/4 z � S00013'7 8'W 334.21' — �c m z o =0 "' 4 OCcO m � mC m -3--- ----- �m xc� c n ' XISTING CENTERLINE $—V `� a m x y m m 7c Om2iJQ ^� �- n .Cn Cn 2 m I J00°42755'E 334.20' --- °z m cn C cn I a RIVEING�1 c��J Co m� N m /0 ale ° m mpM m xn C u, 0 El g Q Lt'p- C o m .a". m ca m � j0 <p2 zC "♦ ° o® o a, xc� 0 5 Z m m°O x p c g c c Z D ,'gyp i zp O m O w z a -4z") -n 0 c cad' �7 mar m ti '7R P -� m c -o0 Z z N i+ Q 2 °O m n 111.58' 222.82' I+ �Zi 5i$m g m m O 2mtoa7J -0 O m JG Z N00°42'55"W 334.20' N q m_m m v= p x m x -+ N N D O7 D O S J� N I S AC pOmmmm m y O W c0 I �O n 2 N y z z 11 R t _ ' �J i (71 2 I D Z M O O zo ° T Z O „y o Nri-a m 5 � iz . ♦� m D I� D m W co i cn I rJ �1�=m= m =1cn m 0 m m m � r N O I p A`m 2 0 O Z •'f I Q o w m I c cn a ZO rm Z 0 i$ m O {am i JC�1 $' m�2 j QD Am I Q O c�ctt�JDo °� �jZ O � 1 m ,r.7 m2� �m O �Cmn N �O mO�mm m ~ D C O ZO C) < Z In m x °J 4 m II • � m rn A � : I * n O n x 0 auJpcncn z � O O z m"+m p cn v m �� T v T m�cn O ymy K x Z o °J m O Z Z m��xc m Oc° O � O mz C) Z V DO m Z m v r�r m N .. O m DF �z� < z m Z tm m 0 A Z -+ � z m m c zm D v cZ ? W g -loy,�� Z -0 m O i m S �ZL7p m u'J m z Z II mzm o mN S� c oz .a C m Z09D m "� < p zp m °z � Q n A C.)m O ~n m m z 7Jm N Z EAST LINE OF THE NE1/4 + v m 116.39' 6 .00' 1 '1.83' N00°22'29"E 2274.97' Nei &2i �+M N00022+29"E 334.22' w z • it z .0 C3La�� dQL'3� �__OM4Cz7 IZi w C3LQ>��dL;1G3C BOO M17th ` 2, ---------- -- I �i2 X04 O �� 'w�/arnnr�ilxMglN�a� 1 of 2 Vol. 23 Page 5553 Parcel #: 030-1075-60-000 05/08/2014 01:14 PM PAGE 1 OF 1 Alt. Parcel M 27.30.19.263B 030-TOWN OF SAINT JOSEPH Current ❑ ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type #of Units 08/15/2008 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner CHRISTOPHER J WEYER O-WEYER, CHRISTOPHER J 1351 CTY RD I SOMERSET WI 54025 Property Address(es): '=Primary Districts: SC=School SP=Special `1351 CTY RD I Type Dist# Description SC 5432 SCH DIST OF SOMERSET SP 1700 WITC Notes: Legal Description: Acres: 3.620 SEC 27 T30N R19W PT SE NE CSM 23-5553 LOT 1 (3.62 AC) Parcel History: Date Doc# Vol/Page Type 08/15/2008 880098 23/5553 CSM 08/13/1999 608536 1449/42 QC 11/12/1990 464042 886/02 WD 02/11/1986 409155 732/92 WD more... Plat: "=Primary Tract: (S-T-R 40%160%) Block/Condo Bldg: *5553-CSM 23-5553 030-2008 27-30N-19W SE NE LOT 01 2014 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/12/2011 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.620 59,200 131,700 190,900 NO Totals for 2014: General Property 3.620 59,200 131,700 190,900 Woodland 0.000 0 0 Totals for 2013: General Property 3.620 59,200 131,700 190,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 12/01/2010 Batch M 10-16 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 030-1075-60-025 05/08/2014 01:14 PM PAGE 1 OF 1 Alt. Parcel M 27.30.19.263B-25 030-TOWN OF SAINT JOSEPH Current 1X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type #of Units 08/15/2008 00 0 Tax Address: Owner(s): 0=Current Owner, C=Current Co-Owner 0-WEYER, CHRISTOPHER J CHRISTOPHER J WEYER 1351 CTY RD I SOMERSET WI 54025 Property Address(es): *= Primary Districts: SC=School SP=Special Type Dist# Description SC 5432 SCH DIST OF SOMERSET SP 1700 WITC Notes: Legal Description: Acres: 6.380 SEC 27 T30N R19W PT SE NE CSM 23-5553 LOT 2(6.38 AC) Parcel History: Date Doc# Vol/Page Type 08/15/2008 880098 23/5553 CSM 08/13/1999 608536 1449/42 OC 11/12/1990 464042 886/02 WD 02/11/1986 409155 732/92 WD more... Plat: *=Primary Tract: (S-T-R 40%160%) Block/Condo Bldg: *5553-CSM 23-5553 030-2008 27-30N-19W SE NE LOT 02 2014 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/12/2011 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 6.380 57,700 0 57,700 NO Totals for 2014: General Property 6.380 57,700 0 57,700 Woodland 0.000 0 0 Totals for 2013: General Property 6.380 57,700 0 57,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00