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HomeMy WebLinkAbout030-2086-10-000 Wisconsin Department of Commerce County: St. Croix Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT Sanitary Permit No: 578906 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: Village X Township Parcel Tax No: Schle City, Michael St. Joseph, Town of 030-2086-10-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: 1100, b CST 6,M , 32.30.19.731 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 1 N� �S Benchmark �S Q � Dosing Alt. BM i ' ��. S Bldg.Sewer Holding- �- StHiffnlet .q7 17 f 01 TANK SETBACK INFORMATION Sb"t-Outlet SO Z • S TANK TO P/L WELL BLDG. Ven to Air Intake ROAD DHntist- S)t tti Septic \ ' bt I Dt-Battorn HeaderNdarrf—br44%) V s.ls X3, 13 Aeratiory Dist. Pipe 11 L Sb 9' �5 /J Hg� Bot.System °I.IS rp, y b PUMP/SIPHON INFORMATION Final Grade B Manufactur Demand St Cover o T4 Model Nu ber TDH Lift Friction Loss System Hea TDH Forcemain Length Dist.to well SOIL ABSORPTION SYSTEM I Pj BED/TRENCH Width Length I No. f Trenc es PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS X71 __ '- SETBACK SYSTEM TO P BLDG WELL LAKE/STREAM LEACHING Manufacturer:' INFORMATION CHAMBER OR 1 V T pe Of System: UNIT Model Number: I �' Nv ?2S � St P N DISTRIBUTION SYSTEM 5 Header/Manifold (.� Distribution x Hole Size x Hole ring �/e�nt t�oQAir In IG I / // Pipe(s) l V l✓ r Length J Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over v ML 2.981 ID epth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center 3.SSI Bed/Trench Edges Topsoil` f es FE] No es No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 403 Rolling Hills Trail Hudson,WI 54016(NW 1/4 SW 1/4 32 T30N R19W) Johnson Parkway Lot 10 Parcel No: 32.30.19.731 CL� n6-E DNS (� ec'li 0✓\. 1.)Alt BM Description �'� 'C�V'A t:1 t�.�i u 2.)Bldg sewer length -amount of cover= , O n G I ) Plan revision Required? Q Yes O(No I Use other side for additional information. Date Insepctor's Signature Cert.No. SBD-6710(R.3/97) AVKr ssc.+Le-rT V �n PRS 22�ZH 2 o � _ .P�N�CtF�rzlr = i�h� --IC6 d= f'' sell SIC �E 1170 S(QPE -0 S61L J?mAgS, d Hjffww kruetd SDIL ,EY4 LUAr1Dm i 5L5 v✓I sE� %Ate pDC U L b E S,r1C- n bLL I 1\JL rl ILLS L► . • . RECEIVED 1 ( ' APR i n ',-1-:, kh, V./.00 c., ON,Ir,::.;NM,'1,2._.V-L0,-*I2NT --r7---, - Count/ ' '''',. --is-,Z:', '1. (.,,,_____ ..(.:. . Safety and&Admit Division 3-1- 2 X6A 201 W.Washington-Ave.,P.O.Box 7162 swop pamitHaather pa be Bled ha by Co.) Madsen,WI 53707-7182 " ---._....,__;.:::--'" • 5-7 8 9 D Sanitary Permit Application Stme Tniusamion .a. In accordance with SPS 333.21(2)111s.Adm.Code,submission°fads foram-dm aspropriate governmental slat is required pdor to ebtabing a maw pee*.Rolm Application forms br state-ovaied POWS are subsist' ed to Project Adthess(ifififferentibas loam address) the Departumnt of Safety and Piefessiong Strom' . Pasonal infoumnien you provide may be used for seconday , purposes iameardenoeuklitbsPrthucylnsv,s.1.1.04(I)(m).Stars. 14 03 FOLU4 MO ifwe L Appliatrzon Infonmsfion-Please Print Aft Information Property Owner's Name Patti d M 1 if‘ SNLEVY 0, o30- zostn- 10-06. Property Owners Aladin Address' Property Location 6 7 i 1 nZg - eieari e/ke Ciy,State rap Code Phone Number lihrt y,,SW v.Seegers 311 tith0-5/V WI alb I,Oink one) T.1) 1 R i 7 E tre IL Type of ifaultrusg(check alithat apply) Lott „y4 or 2 Family Dwelling-Number afflakerans 5 i , d) 1U Subthvisicallame 0 Pultheraninescial-Describe Use a elY 6t)) Modal ' .10 diiiii P w , J • • i OF 4.---. 0 City of CE641,1amber 0 Village of o Stake Owned-Describe Use 0\°‘1461 - alTown of SI• (..1,6E- 44J- - in_ • , ,, _ ,,, Cheek OW one box on Hue A. C.Oluplete line B If Applicable) - Z 0 ru--X A'4 74 New System 0 Replacenunt System 0 Trasonandiebrusg Tank Replacanent Ordy 0 Other Mod rficadua to Evisfiagthjessas(explain) 7 015-/YirbOtibn cells 1")/ 2-1 chafribt es ?ach ! LiSt Previous Pennitkitunher and Date hoed- B. 0 Penal Renaud 0 PandtRevision 0 Change ofPlumber 0 Penak Translate Hew Before Expiration Owner 1,.......1.4 ,,.., - 1 .:,L7 , , ,, I -- Check all Oat — ig1 ,, *•.-- In-Gronad 0 :, — b-Oruand 0 At-Orade 0 Mooed>24 in.ofsuitable son 0 Mound<24 in.amiable soil H,'iM a c. - Disposal Convenes(=plain) 0 Pretmatumat Device(-•‘ it ' I/ V.Dispessalfrreabliest Area Infonnalion: . T1 aul ' - A i . "----:-.•"*"." • 5 -Design Flow( / Design SayNation Ithie(gaki) Dispersal Area Rct71($0 Dikpassel Ana Proposed(sl) 1 System Bendel 'j, C(0 1 —7 5b t/ .*7 1072 l'IbeD v I7C- "V-I owl?) t ' VI.Tank Info Capacity in Tatal 0 of Mannfactuter Gallons Gallons links 1.1 5 ttog Tyska Eat'deg Teaks WI' i)frffati -fi lie if 2 mi Sec&arliafise Tank i /5 • 4,5 vi ITC/5 17/ ' T1 ESCA---. irNe 1_ r Dosing' Chamber . VII.Responsibility Statement-I.the naderi%wd,assume for insialialian of the powrs , , , the alladted PIM Plumber's Name{Print) . 1,,4.1.wr., ,. , . Business PhoDelluraber - F Fokl_ C -rtnt 973V-14 715- I'M 31/5/3 Plumber's Address(Sima,(ity.Sone,Zip Code) fo. goy_ 5. 3- bRESSC-L vv) 9'1067 Aryl Conn # -,, , • -,t Use Only Ell ApPmved i 0 ,.s.- ,, Faulk Fee Date Issued issuing ,- / if I / I Om=Oval Reason for v- L--1/5.°, 1//10/1 DC.Conditions of Approval/Reasons for Disapproval 44-p Ltak (i' e ba-4. / 7 SYSTEM OWNER: 1.Septic tank,effluent filter anc dispersal cell must be serviced/maintained as per management plan provided by plumber. 2.All setback requirements must be maintained as per applicable code/ordinances. Mo.X Sti �-e fr, bii fU b-e 5 r b-e�ow jraeLe._ • Well tt4VS+ t3 I Z J--ba ✓ego1.1 t �O . see e fi'or►S h v e re iktaintd v/tchct,ncjed G ,vt t o-( ,h$�Gi l/ s_-t,',r1 • CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: N1[l"E Sl!I)LE fY Owner's Name: Owners Address: 1629 CRE3LElJr ZVILE ,VVttSNU WI sy0/t Legal Description: _ NO/ SW I S 32 7-.2t) NA /7 w' Township: S n37)ES t' eR County: ST lY Subdivision Name: 'bN106/J .PAEAVYN Lot Number. Parcel ID Number: 60-4A- 10 -NO Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing&Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test& House Plans Designer/Plumber: IEP f^ /jL License Number. />FIMS 2222'IL Date: 51191/5 Phone Number 7/5-Lj/9I-2'/55 Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P(N.01/01). Page 1 AMU-Kc sc+ILEI'T LET ID 1YA1 6F' ..IPM\600 PARKWAY -OW ® i h' , i LR.0 LTY joiy ti P>z s 223211 Z. _ yY yb V EctvEvire*R1( -irb?7 sG) yC 17119 P-170 su Pc ALE oX? r1 1v�7 /IUc,E t god_ LI/-Il_fI t 4/6" n /565 vviEc-re_ -rAoL 1303 17/60.t C. of s I�tLI,I,'4 rlILLS L.•i', Soil Absorption System Cross Section 95 ft „we 4°Schedule 40 PVC Vent Pipe s� With Vent Cap I ft Final Grade Leaching __11 9 Chamber ft System Elevation ft Soil Absorption System Plan View ft ft f1I111 fIIIIlI111111111111111111I11111111111111111111111 111111111111111111111 1111 - 7-6 ft Leaching Trench 1 Vent Or Observation Pipe Chambers --1 1IIIIII 11111111I11II1111111I11hI1111111111111111111111111I111111111111111 114 111*—�4*Dia. Trench 2 Header Leachino Chamber Specifications ,/ !� Manufacturer And Model mintg i` C QUICK 7 5 dar�� rIts EISA Rating 20 sq ft per chamber Soil Application Rate /7 gpdfsq ft 75b gpd Design Flow÷ /7 Soil Application Rate ; 2/5 EISA= 9y/Chambers 2 rows of 27 chambers each. Page of S vs 3' . ' .13 AT'6 I >,,g t^"` Ali d. $ T x+ .` +. r e '' R , to ?� nib r. t' 0-':o f : , n g '� i�Y 1' l k R � 9 M Installation and Maintenance Instructions Installation Step 1 Dry fit the filter case onto the outlet pipe going to the drain field.Ensure it is centered directly under the access opening.(if outlet pipe is already in a fixed position,additional pipe may need to be added) Step 2 If utilizing the additional single side support and the two bottom supports: While the case is still dry fit to the outlet pipe,measure and cut 1"schedule 40 pvc pipe to the length needed to extend from the hubs that are pre-molded into the case to the side wall and the inside floor of tank. solvent weld pipe into the hubs that are pre-molded onto the case. Step 3 Solvent weld the case to the outlet pipe.Insert the filter cartridge into the case pressing down on the cartridge until it locks into place at the bottom of case. Step 4 if utilizing a vertical read switch:Insert switch into the hole pre-molded into the top of the filter.Press straight down until it locks into place Maintenance 1) Remove the access lid of the tank. Note:To ensure undesirable solids do not exit the tank and into the drain field,the tank should be pumped out until the level of effluent is below the outlet level of the tank. 2) To remove the filter cartridge from the filter case,pull up firmly on the handle of the cartridge dislodging it from the case.(if utilizing a vertical read switch,removal of switch is optional) 3) Using an ordinary garden hose,rinse the filter cartridge ensuring all visible septage material is removed. 4) Place the filter cartridge back into thefilter case pressing down on the cartridge until it locks into place. • 5) Place the access lid back onto the tank ensuring it is secure. . Lifetime filter has a lifetime limited warranty: Lifetime filter LLC warrants the filter will be free of manufacturing and workmanship defects during normal use for the period of time the original purchaser owns the product.Lifetime filter will provide a replacement filter in the event that the original filter was i6 not damaged during the installation or maintenance process.Damage to this product caused by accident,misuse or abuse will not be covered under this warranty.Improper care or malfunctions resulting from product not being installed,operated or maintained properly will void this warranty.Lifetime filter assumes no responsibility for labor charges,removal charges,installation or other incidental or consequential costs. Contact:mike @lifetimefilterlIc.com Phone:502-724-2231 .r POWTS OWNER'S MANUAL AND MANAGEMENT PLAN ' FILE INFORMATION SYSTEM SPECIFICATIONS Owner MI SCE zr--r r LE 11 ' Septic Tank Capacity / 9 gal D NA Permit# Septic Tank Manufacturer %/I 0 O NA DESIGN PARAMETERS Effluent Filter Manufacturer Ll r M E p NA Number of Bedrooms 100gpd/bedroom . In NA Effluent Filter Model 1i4 DNA NA Number of Commercial Units S.NA Pump Tank Capacity gal)4 NA Estimated flow(average)* 5 00 galiday Pump Tank Manufacturer Design flow(peak),estimated x 1.5* 7 50, gal/da Pump Manufacturer NA y Pump Model A _Soil Application Rate gal/day fl Pretreatment Unit A Influent/Effluent Quality(NAD) Monthly Average** ❑Sand/Gravel Filter 0 Peat Filter Fats.Oil&Grease(FOG) 5 30 mg/L D Mechanical Aeration D Wetland Biochemical Oxygen Demand(BOD3) <220 mg/L ❑Disinfection D Other Total Suspended Solids(TSS) Manufacturer: Model: <250 mg/L Dispersal Cell(s) Pretreat ffluent Quality r► Monthly Average*** X41-ground(gravity) ❑In-ground(pressurized) Biochemical ► ! ■ ,d(BODS) s 30 mg/L 0 At-grade 0 Mound Total S .. , • Solids(TSS) < 30 mg/L ❑Drip-line 0 Other: orm(geo 'c mean) <10 cfu/100m1 ❑Leac,.,:Chamber Manufacturer /iVr/Lrt 0.51.012r. Maximum Effluent Particle Size 1/8 inch diameter Model"0(MC 7 Laying Length/Chamber *Wastewater Flow Verification and Calculations: Soil Application Rate , j gpd/fl Area Req.ja ,- (Other than bedroom based) Infiltrative SurfacelChamber-ESIA Ra g 2Q Minimum Number of Chambers 0 Aggregate Design Flow/Loading te= ft2 min ** Values typical for domestic(non-commercial wastewater Materials:all materials must comply with WI Aden Code and septic tank effluent. COMM84 and be installed per manufacturers specifications ***Values typical for pretreated wastewater. and approval letters. • DESIGN CRITERIA ❑ "Wisconsin At-grade Soil Absorption System,Siting,Design&Construction Manual"(Converse et a1.1990) D"Wisconsin Mound Soil Absorption System:Siting,Design&Construction Manual"Converse,J.C.and E.J.Tyler. Publication 15.22 ❑"Design of Pressure Distribution Networks for Septic Tank-Soil Absorption Systems"Publications 9.6 D"Design of Conventional Soil Absorption Trenches and Beds". R.J.Otis-ASAE Publications 5-77 and"Design Manual- Onsite Wastewater Treatment and Disposal Systems".EPA 625/1-80-012 October 1980 D SBD-10570-P(R.6/99)"At-Grade Component Manual Using Pressure Distribution" 0 SBD-10567-P(R.6199)"In Ground Absorption Component Manual' $BD 10705(N.01/01)"In Ground Soil Absorption Component Manual"Version 2.0 0 SBD-10628P(N.6/99)"Recirculating Sand Filter System Component Manual" 0 SBD-10656-P(N.6/99)"Split Bed Recirculating Sand Filter System Component Manual" ❑SBD -10572 P(R.6199)"Mound Component Manual" 0 SBD - 10691-P(14.01/01)"Mound Component Manual"Version 2.0 0 SBD - 10595-P(R.6/99)"Single Pass Sand Filter Component Mannar 0 SBD - 10657 P(R.6/99)"Drip-line Effluent Disposal Component Manual" D SBD - 10573-P(R 6/99)"Pressure Distribution Component Manual" ❑SBD - 10706-P(N.01/01)"Pressure Distribution Component Manual"Version 2.0 0 Drip-line Effluent Dispersal Component Manual for Multi-fib Onsite Wastewater Treatment Units 0 MAINTENANCE AND MANAGEMENT MAINTENANCE MONITORING SCHEDULE Service Event Service Frequency , Inspect condition of tank(s) At least once every :.3 0 months Oryear(s) (Maximum 3 yrs.) • out contents of . .t s When combined slud:e and scum: uals one-third 1/3 of tank volume ,: - a At least once ev.1 ❑months r s „ 3 . Clean effluent filter At least once ev , 0 months re 4,1 s Inspect pump,pump controls&alarm At least once every ❑months 0 year(s) ,. NA Flush laterals and pressure test At least once every ❑months 0 year(s) 11 NA ,. NA •�_1 __ At tPACt An,-P rv,!ry n months ❑vear(s) .. .System start up shall not occur when soil conditions are frozen at the infiltrative surface. 4, OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports.The quantity and quality of the wastewater stream will affect the performance and longevity of Your POWTS.The installation of water-saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume.Also the brine or waste from water softeners,iron removal units,other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible.Note:this does not include laundry waste,showers,dishwater,etc. This system is designed to handle domestic strength wastewater,however the disposal of food based greases and oils,vegetable/fruit peels and seeds,bones,and food solids such as those produced by a garbage disposal should be minimized.Toilet tissue is the only paper that should be discharged into the system.Other non-biodegradable items such as baby wipes,tampons,sanitary napkins condoms,cigarette butts,dental floss,and cotton swabs should not enter the system.Chemicals such as petroleum products,paint, disinfectants,pesticides,antibiotics,solvents,etc.,should not be flushed into the system as they can seriously damage your POWT'S and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week.Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. p Valves Valves shall be operated in the following manner: ❑Alarms Alarms should be tested on a regular basis by the home owner.If an alarm sounds,contact an individual licensed to service POWTS,There is normally a 1 day reserve under regular operating conditions,however water should be conserved until any problems with the system are corrected to prevent back-up of sewage into the dwelling or surfacing. INPECTIONS Inspection shall be made by an individual carrying one of the following licenses or certifications:Master Plumber,Master Plumber Restricted Sewer,POWTS Maintainer or Septage Servicing Operator(per the attached Maintenance Schedule). O Septic Tanks Component Tank inspections must include a visual inspection of the tank 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 backup or ponding of effluent to the ground surface.Access openings used for service or assessment shall be sealed and/or locked upon completion of service.Any defects shall be promptly corrected.Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one-third(1/3)or more of the tank volume,the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with Chapter NR113,Wisconsin Administrative Code. The outlet filter(s)shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications.Provisions are to be made to retain solids in the tank.Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. Cl Pump Chamber/Treatment Tanks Component The inspection must include a test of all electrical equipment such as pumps,alarms and floats.A visual check must be made for leaks,backups,surfacing,missing or broken security devices and other hardware and the condition of any filters. Any service needs or repairs shall be promptly taken care of. ❑In-Ground Gravity Component Dispersal Cells The inspection shall include recording the levels of ponding,if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge.Any discharge to the ground surface must be promptly reported to the regulatory authority.Ponding at depths greater than 75%.of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. Page of • ❑bound,At-Grade,In-Ground Pressure The inspection shall include recording the levels of pending,if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge.Any discharge to the ground surface must be promptly reported to the regulatory authority.Ponding greater than 75%of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The pressure distribution system is provided with an opening at the end of each lateral to be used for flushing.The laterals should be flushed at least once every three(3)years.Pressure checks of systems with multiple laterals should be done to ensure that equal distribution of effluent is occurring to promote the longevity of the system. REPORTS Reports for maintenance,inspection,and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch.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 other 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 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 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 available 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 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>> SEPTIC,PUMP AND OTHER TREATMENT TANKS MAY CONTIAN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC,PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES.DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name -r-F- Name Phone 115 75-5' VI 6 Phone SEPTAGE SERVICING OPERATOR(Pumper) LOCAL REGULATORY AUTHORITY Name A,enc STAMMa ..J � n Phone Phone y r so 10/2006 KAWPDATA\EHIPOWTS OWNER'S MANUAL.doc Page of ST.CROIX COUNTY SEPTIC TANK MAINTENNANCE AGREEMENT AND OWNERSHIP TCATE FORM Owner/Buyer kk2 0r/`GGL CC , Mailing Address G L� (�YG�S IiGG�/ �c- 4 /hh � u)-r. Property Address `/03 /`'tal('n9 ieskilf Z4t4.t L (Verification required frA Planning Department for new oonstrudioa) City/State IISDfl,I(4..71 Parcel Identification Number 03 0 — 2.0 B V/' J b - 00 0 LEGAL DESCRIPTION Property Location/+i W1/4,6W v. Sea-k t N R J W,Town of ST. Subdivision JDfi, t'a ) xi<AvtNy Lot# /d Certified Survey Map# ,Volume Page Warranty Deed# ,Volume Page Spec house yes no Lot lines identifiable Ryes no SYSTEM MAINTENANCE Improper use and.maintenance of your septic system could result 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 fimction of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St.Croix Zoning Department a certification form,signed by the owner and by a masterplumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on- site wastewater disposal system is in properoperating condition and/or(2)after inspection and pumping(if necessary), the septic tank is less than 1/3 full of sludge: Uwe,the undersigned_haveread_the abovesequirements and agree to maintain the private sewage disposal system with the standards set forth,herein,as set by th Department of Commerce and use the Departmetit of Natural Resources, State of Wisconsin.Cedificatiou dating that your.septic system has been maintained must be completed and returned to the St.Croix County Zoning Office within 10 days of the three year expiration date. 711 4/5/1 11,41 SIGNATURE• APP •- DATE #of proposed bedrooms 6 OWNER CERTIFICATION 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: SIGNATURE• • DATE ****** misrepresented result in the sanitary permit being revoked by the Zoning Departni 3t * Any information that is m;sepr may " Include with this application a aang ed warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made inihe warranty deed. . I $ \r y LOT 2 w. LOT I a ti"p `N��1 ,.....,5 N........., 130,689 SQ FT. p -�� ..t.. N1• `` 3.00 ACRES, n q 173,993 SQ. FT. M '�(n 2 >3►: ACk , .0 E N90.00 00 w \G i� - _ ' 23.92' — 26.081 \G� -''` � 363•35'05E 8 /•-:__ ""'''''''''''''•••••�` \C� \ �H) h 50.00' -- g 33,00'—� L L.s ct ''' 1 /'°69•'42.'' O Q ' yam\ `{7 ` `? I�.is'. 286.85' N '. S�:WS'-:.� p \\\��„`....,, `+ 889•SI'�°E 420.E , x• : °`:^�,�,�`"Zy \ N90 00'00'w \ ., 2' - - LANE - %�`�03°° 50.00 `.``' .• ( �e °-- N89°51'28*W 420.00' ii 9 ` N63.35'05"W,-.. 103.00' - 260.00'----- 57.00 - `�\0 • 50.00' /• N L. •39,■ . LOT 13 -- ................._ ............�,. W., N..... \\ N /// 163,648 SO. FT. ` s• "^+� 1..y, a ,y,/ 3.76 ACRES i '$'a, O ••�G7 ti '�J,$* ` EL. • U,.• LOT II _ /'4. 6.v • 0. 1 s 152,865 SQ. FT. p to 3.51 ACRES z / "N90.00'00"E 529.38 S1 70.00' • N 1 459.313' LOT 10 , • N90.00 00 E 310.4 81,082 SQ. FT. 4.39 ACRES $ LOT 2, CERTIFIED SURVEY NIAE • a VOLUME 1 PAGE 60 IN ? PaGE 2C 93•0Q' ---17x.49'--- ----w'" a' .8 DOC. NO. 444406 I $90.00'00"E 273.49' { i 1p - 04 , J + in 1 `1i . , ,DIN •i8'17':w 01 / N90•0Q:00"Mt 273.49'- ' 401.00' 10 // --91.77 -.181.72` w:. / 1 _ J ;i. .. x LOT 9 8 °o e LOT 8 176.912 SQ' Ft. +;3 .pb ACRES 132,862 SQ F7 �M 7/ / 1'115 ACRES ' * LOT 3, CgRTIFItO SURVEY MAP EL. • •*s.s 4411 VIE $, ' ^E 22 ice. 140. 451§ ti ;,.a a.r, $ .� `,, 1,".1 d .. ': 7T t •• ± .` .-4. 9 '"`".".a , Aei A E u,...>y, 1799 .4' SOIL EVALUATION REPORT Wisconsin Department of Commerce Page 1 of 2 Division of Safety and Buildings in accordance with Comm 85,Wis.Adm.Code A.C.E.Soil&Site Evaluations Attach complete site plan on paper not less than 8%x 11 inches in size. Plan must County P P Pape St. Croix include,but not limited to:vertical and horizontal reference point(BM),direction and Parce I.D. percent slope,scale or dimemsions,north arrow,and location and distance to nearest road. 030-2086-10-000 Please print all information. viewed BX D a Personal information you provide may be used for secondary purposes{Privacy Law,S.15.04(1)(m)). (/0 Property Owner Property Location 1\1\1(hail A FYilen c,4\ J Govt.Lot NW 1/4 SW 1/4 S 32 T 30 N R 19 W Property Owner's Mailing Address " -y",1.rEE a F' Lot# / Block# Subd.Name or CS (e/5/J 438 Rolling Hills Trail 101 Plat Johnson Parkwa City State Zip Code Phpne,gllg4 er j City _ i J Village Town Neares Road 03 Hudson I l 1 5.104$ I ° �LUUUU'�t St.Joseph I Rolling Hil s Trail N' New Construction Use: ReeldleEatto�ll Q'bedr•• s Code derived design flow rate 600 GPD _;;f Replacement Publib• •A••- . - Describe: Parent material Glacial outwash Flood plain elevation,if applicable na General comments and recommendations: Evaluation completed by hand auger to verify soil conditions as reported in original soil evlaution report, dated 6/7/92,completed at time of subdivision approval. --I/ Q ("i tht ? NOT/c/F/L -_(/s&T s Boring# e Boring 77/4S l`'0 e- Pit Ground Surface elev. 98.05 ft. Depth to limiting factor >96" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-6 10yr32 none sl na na na na 0.6 1.0 2 6-24 10yr4/4 /'5 non sl na na na na 0.6 0.8 ' 3 24-32 7.5yr4/600 GJ\ me Is na na na na 0.7 1.6 4 32-96 1 0y r5/6 ‘1 , g ne s&gr na na na na 0.7 1.6 \Ati 1 5 54-cnv..��+; 11 11 " � DIA) (ate' Soil applicatio rates estimated sad on texture and apparent structure. 7 Boring# e Boring Pit Ground Surface elev. 98.16 ft. Depth to limiting factor >96" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-6 10yr32 none sl na na na na 0.6 1.0 2 6-34 10yr5/4 i none sil na na na na 0.6 0.8 3 34-40 7.5yr4/6(\a`` , -Q' orje Is na na na na 0.7 1.6 4 40-96 10yr5/6_ a Iltit)se s&gr na na na na 00 1.6 IAti Soil appli n rates timated based on texture and apparent structure. *Effluent#1 =B O D 30<220 mg/L and T S>30<150 m L i * ffluent#2=BOD5<30 mg/L and TSS<_30 mg/L CST Name(Please Print) ignature: CST Number James K.Thompson �"'"— 3602 Address A.C.E.Soil&Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane,Osceola, 54020 5202004 715-248-7767 •Soy/era/60,6o'-)/2,z • Exisir.7 grade e I e dafb∎-f 'gage: ©�� ;ha./a 4/o%s& y ed. ,9// e da.Cacho» •f/andau eicd So.% are read,/y obstr✓a.b/e And to-ere/ocaed. /Ie.,,1/42 SvQ/u ^�a�� Cork!' 9'''s ,(denLItrrbr4 a-ad grads ele✓a i-onS a6 Soy//o/ES 5ca//:/ 'Sr ' N W iert esZa.Z/s{col 4,7044.00os es o{' rs ►/�►�� 8/ : 99.50' .Ted'J ohnsdY),(-0-/at/Sy 32= 99.'93' /o /,of �/a o c J-0 L,ns' Q3 9752' /OarKr.Jcy, Sec . 32,771. of 5� Toscol, 5E.CroiXCo,64)I. .34I : 9937' 93.08' 8Z Bs - 94,0' . 96,0' 9721 •83 97,28' 980' •81 g�( .35 /ap.o'c-0nto.,- .ea !?ark. T- 1'/" /9,1 sheet fl,roc,cf4 11 . O C. 4/ " Sy5fevn Arty Assumed elev'• =/do.cry.' M r./ eRUi/y 43cnd4al �► /9%o 5/cot 1�. .u. ✓IGt;I .n Z.Z 02,re/ee. 4-lee=/2Z. Proposed Wieser C'av,c re ,4/j bLl pia) e )'4 Gt3), /a7sty drat outl • Pro po s4.d 6 room dwelling a F—propastd,_.dell Ve e�oP° //ca'//y 1,300 c42,01 Cc�C-de-Sac Pol/ina f>,//S Zane �o�cn' Parcel #: 030-2086-10-000 03/24/2008 10:28 AM PAGE 1 OF 1 Alt. Parcel#: 32.30.19.731 030-TOWN OF SAINT JOSEPH Current X ST.CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): 0=Current Owner, C=Current Co-Owner O-JOHNSON, SHARON R SHARON R JOHNSON 6165 BEACH ROAD N APT 2 STILLWATER MN 55082 Districts: SC= School SP= Special Property Address(es): *=Primary Type Dist# Description *403 ROLLING HILLS LN SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 4.390 Plat: 05-093-JOHNSON PARKWAY SEC 32 T3ON R19W 4.39A PT N1/2 SW1/4 Block/Condo Bldg: LOT 10 JOHNSON PARKWAY LOT 10 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 32-30N-19W Notes: Parcel History: Date Doc# Vol/Page Type 01/03/2008 866638 QC 12/30/1998 594701 1391/168 WD 07/29/1998 583915 1344/71 ALC 12/31/1997 570628 1285/487 LC 2008 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/12/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.390 69,400 0 69,400 NO Totals for 2008: General Property 4.390 69,400 0 69,400 Woodland 0.000 0 0 Totals for 2007: General Property 4.390 69,400 0 69,400 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 May 01, 14 08:40a Jeff Fox 1-715-755-2464 p.1 . ! s 1 ........... /1 12 ■....,,,, v • 1 • -• ,z,.;.;,.....;5 ''., . I. . I ,.) 'i ,... 0 - 71 „..,(j LD \.)(.) 0 c7 . VCS c.S .i. :, ,,•_,, , • ‘....•. ,..c... t* 4 • 1,.....› ,..): d .:;4 we,' .,.. a • 1 i sr. ,-.'..•..' ':'i : 4 : i•."'... 4 . '-' ' ;■ _.,,.. • i ,....., I' it ' ".:,;• 7 .. •.: 1........ ..,.. 7'...:$ ..m.l.' 7' .k..7.:7.- d.•.,i... V• 41 .'..• 4..... ) I 5 . -7 S3 5 . ai--1 u ( i ... . . . Parcel #: 030-2086-10-000 05/01/2014 09:25 AM PAGE 1 OF 1 Alt. Parcel#: 32.30.19.731 030-TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type #of Units 00 0 Tax Address: Owner(s): 0=Current Owner, C=Current Co-Owner O-SCHLETTY, ERICA L&MICHAEL R ERICA L&MICHAEL R SCHLETTY 1029 CRESCENT CIR HUDSON WI 54016 Property Address(es): *= Primary *403 ROLLING HILLS LN Districts: SC=School SP=Special Type Dist# Description SC 2611 SCH DIST OF HUDSON SP 1700 WITC Notes: Legal Description: Acres: 4.390 SEC 32 T3ON R19W 4.39A PT N1/2 SW1/4 JOHNSON PARKWAY LOT 10 Parcel History: Date Doc# Vol/Page Type 04/18/2008 873000 WD 01/03/2008 866638 QC 12/30/1998 594701 1391/168 WD 07/29/1998 583915 1344/71 ALC more... Plat: *=Primary Tract: (S-T-R 40%160%) Block/Condo Bldg: *05-093-JOHNSON PARKWAY 32-30N-19W LOT 10 2014 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/11/2011 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.390 48,600 0 48,600 NO Totals for 2014: General Property 4.390 48,600 0 48,600 Woodland 0.000 0 0 Totals for 2013: General Property 4.390 48,600 0 48,600 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 May 01 14 08:41a Jeff Fox 1-715-755-2464 p.4 / - &Zara --6441Sevid , . . I- Sort X J ,0a,.. - � ,„ ..../.../....,.,....;, Soy/ ..ene%-'5 r — /_Ire,s• J .7:-.24 - - :s t- • 11 /� . . . .. fad iii ...\\• ,..- 46921 ._.. iftkorr30,,,. t • . J66.116....., 1 e‘3%...31-----------1-627' . . - . . • .ter .f. 1 . 1\ ill- .1139 Axes - . , . 4=7.4.s- . . 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