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HomeMy WebLinkAbout018-1034-90-000 v ; PRIVATE ONSITE WASTE TREATMENT SYSTEMS County / iins//l ( POWTS) Department of Commerce INSPECTION REPORT St. Croix safety and Bu itd no Division (ATTACH TO PERMIT) ) Sanitary Permit No: GENERAL INFORMATION 483969 Personal information you provide may be used for secondary purposes [ Privacy Law, s. 15.04 (1)(m) ] State Plan Transaction ID #: Permit Holder's Name: City Village X. Town of: US BANK NATIONAL ASSOCIATION 406‘...,,44 o`.- <0 Parcel Tax No: CST BM Elev: Insp BM Elev: /e0 BM Description: 8 nn 1 6.5r 018- 1034 -90 -000 TANK INFORMATION ELEVATION DATA 4 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic W i !e,S+.ti moo Benchmark S Zb i66. ZO 13eetl, 1l.4a.. AL) /Sit 'Z' i F; Cc.•,ar -- b76 fl /0 3. 5 Aeration Bldg. Sewer 4 6 /a/ _ z Holding St/Ht Inlet 1 7i 1.5 /00 _ TANK SETBACK INFORMATION St/Ht Outlet 4"A 75 lob 5 Tank TO P/L WELL BLDG VENT TO ROAD Dt Inlet AIR ' W �� / INTAKE Dt Bottom Septic ( 3 3 9 , I NA Installation i Contour A14- �� Dosing __ 7/1!� NA Header /Man. g ,tk, 74, , IS Aeration � , NA _ Dist. Pipe b2.- Holding /6� 1 9S Infiltrative PUMP / SIPHON INFORMATION Surface I "LIZ) 91 Ma cturer Demand Final Grade 4 , c t 1 5 , 1 Mo el Number GPM TD Lift Friction Loss em Head TDH Forcemain — Cength - 1 - Dia (Dist. To Well DISPERSAL CELL INFORMATION DIMENSIONS Width Length / No of Cells 3 � ype of System Manufactuer 9 Well OHWN of Nav Gc,�oe,n�,a� ¢ LEACHING v� SETBACK P/L Bldg i ` l---f. INFORMATION z Waters CHAMBER Model Number: CELL TO / A / z J DISTRIBUTION SYSTEM X Pressure Systems Only Header / Manif9ld l .� Qbs Distribution Pipe(s) X Hole Size X Hole Spacing ›,k1-• ervation Pipes Length Dia ! Length Dia 'Spac �� S _ No SOIL COVER > 2r•1) Pfe,r•,, e Depth Over Depth Over Depth of Seeded / Sodded Mulched Cell Center Cell Edges Topsoil ■ Yes _ No �es _ No COMMENTS: (Include code discrepancies, persons present, etc.) 0h SQL._ g 6.4,!�s .1- `,.3Gkb cue,- C�I.� ,5 3 � / 1 -QA, x+ � � Ali Plan revision required? _ Yes ∎ No a Z � k amour � 0 1 3 1- t 7 Use other side for additional information. D Date POW f S Inspe.. 's S /ature Cert. No. Bureau of Field Operations, PO Box 7302, Madison, WI 53701 -7302 SBf3 - 6710 (R 3/01) CQnwnercat#ILgov Safety and Buildings Division County - J 201 W. Washington Ave., P.O. Box 7162 `/ �'� - ,4 - S1 fl Madison, WI 53707 -7162 Sanitary Permit Number to be filled in by Co.) 8 P i S3 •'7 Sanitary Permit Application ` � j State Transactio Number I n accordance with s. Comm 83.21(2), Wis. Adm. Code, submission of this form to the appropriate go e /V/1 unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information y rrovide ' ma w be used for s secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stets. �i I% i`,, °" 1.1t..., / / � Q I. Application Information — Please Pri AU Information R 4 v C /p ! Sr Pro Owner's Name / , U AUG 2010 d Parcel # Property Owner's Mailing Address G L9 - 'd Al2.. U 2 4 2010 P rop rty Location 3 y - g � - Q �� /36 l D, t X C OUNTY 6 ' 24 7 & G ovt. Lot i State Zi e ZOINO OFFICE C, , ity, p 5 W A, NU 'A, Section / (o 17 'f w. � , _ _ _ G(,C2- j' O % r!o 7/5 3t1zG O !v (circle one) II. Type of Building (check all that apply) Lot # y T N' R 7 IA I or 2 Family Dwelling — Number of Bedrooms 3 d t Subdivision Name 1/v P//1 ❑ Public/Commercial — Describe Use " 4* Wii8t, , ". //q ❑ City of 0 State Owned — Describe Use / / CSM Number El Village of 3 O;t CeJl�j I.cJ /-/ d' "5 GGtadoe°`,i ® Town of h/0.4, III. Type of Permit: (Chec ly one box on line A r Complete line B if applicable) /9 Q,, , s a A. New System Replacement L1 Treatment/Holding Tank Replacement Only Other Modification to Existing System (explain) System B. ❑ Permit El Permit Revision ❑ Change of ® Permit Transfer to List Previous Permit Number and Date Issued Renewal Before Plumber New Owner . n Expiration / Jam, IYe (_, IV. Type of POWTS System/Component/Device: (Check all that apply l_ ht �,� , p14 Non- Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade fl Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil Holding Tank U Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: `3 ^ /S - •t. T Design Flow (gpd) 7 Design Soil Application Rate(gpdst) Dispersal Area Required ( Dis Area P sed (sf) System Elevation i / i /5 - 6 / o / y > S ao Pro 117,4 9y ./ VI. Tank Info Capacity in Total # of Manufacturer m Gallons Gallons Units o w v New Tanks Existing Tanks 4)0,0t O 6zs F m < ri m a Septic or Holding Tank jb i 00 1 `DOD 4.4 a ..r Dosing Chamber C C C C _ VII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS town on the attached plans. PI is Name (Print) Plu , l' s ,' ature I PRS Number Business Phone Number RA Y GEC- _ o7da 7/S- 766 -.695 Plumber's Address (Street, City, State, Zip Code) P /.36X e 3 hli tspe/ Gum 5 V IIJ County/Department Use Only Approved Disapproved Permit Fee Date Issued Issuing t� t Signature/ / a Denial $ 75 �) j ' IX. Condi easons for Disapproval / 1� / n 1 Septic tank effluent filter and 3 61,E b - • • • ' 4 • 4 E A- O G dispersal cell must all be services f maintained ) as per management plan provided by plumber. 1 52.A. Gp S Q, . Z: All sgtbackrequirements must. be maintained as per applicable code / ort ces. 184 Jr— 4- , /Ie �o Ate e w r.n-G� 1,0 Attach to complete plans for the system and su it to the County only r n p p ys o Cou ty on y on pa�e fv J Jc e not less than 812 x 11 inches in size tl 5 IM.a2' ' I1.1 I&. (-Q, : v\.13( 0-4 . SBD -6398 (R. 01/07) Valid thru 01/10 r , Vaivk (.-A-tiv-tyz- A t a. gm -1 ,gam,„ 1 s . 967 l 70 s T ,1) e s - �v /r,�t c.,, � "" , 1 mat/. Aort AA-L-t- ( 7 ; , ; / ../...e/ - 51,1) c.,,,,_ a' /3, ,-/,/34)-1-0-/ s" X el e of / X B -2 ,> /r / X8-3 9 , 8 v N-w" /boo , .1 4 o p.^ 3 , 7 ' i\ ,,,, NA, . 1 * 0:2J._' :(— I L (2, e 7 i `i`13D3`/ x K �� I 13-3 x aM-a Q's sue- / 4.-d-;-.R- 60 1 7, c., Haa03,57/ p er 1.)-A-tiv-r- I t a' Dili -1 g ,--/ s..Lf 967- / 70 377 N dvt ,5 - N/ u / rr _ I / / /b0 `5 C3..c� ( 7 / 3111- / /3v A-- eff s`rl' J m A A 99, ;;_l_Lei, N ik X C a l q e. 6 ( 504- X f3-a � / /,-5' 4 X �3 -3 n58 I New' /6 sa y' F y 14 '3 - /5 7 c) i r ,,,_,A S v � , 7i/ L . r •=t12 1 1/ X I: 6 3 €, _ ,: 5_111,1 1 x sa id 4. i -Ivry 114,, )d 0357 / ti o . to . Leaching fe........\_ - '.° ,. =tion S tem Cross Section © p `_` ft ED yg - �0 - A 4' mute 40 Final Grade PVC Vent Pipe INith VentyCap � /.5 ft t ) _ ni__ .....0. Chamber 9y ft System Elevation a ft y ft ft Soil Absorption System Plan View . ft aft � : { IIIIII;1 111IIIIII111IIIlIII111111I1IIIIIIIIIIIIIIIIIIIIlIIIIIIIIIIIlIII11111111 :F 11111110 17 ft Leaching Trench 1 Chambers • I II 1 1111111111 • IN 4" Dia. Trench 2 Header Vent Or Observation Pipe I111IIf 111111111 111111111111H l ' ill [1.III11 1111111.111110 Trench 3 Leaching Chamber Specifications Manufacturer And Model ,, // QL EISA Rating sq ft per chamber Soil Application Rate o .6 gpd /sq ft /5D gpd Design Flow ÷ - S Soil Application Rate ÷ EISA = Chambers 3 rows of /.S chambers each. Page of /3A/ // ,P, t=1 ? $ P A I Wisconsin Department of Commerce . SOIL EVALUATION REPORT Page J_ of a Division of Safety and Buildings in accordance with Comm 85. Wis. Adm. Code G.{� c � Attach complete site plan on paper not less than 8 1/2 x 11 inches In size. Plan must County o.I � , _ t y Include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. • ° Q — - Co - o - • Please print all r • •• F� - t R- o we r' / Date �I Personal Information y•u provide may • e used • sacc I� / •- ►w gsiMPT19T£y Law, s. 5.04 (1) (m)). u Vii......` 1 8 / 7 /d .1 Prose Owne I syT'W'• ( " - '. pap,W/ ' . Lot S W 1/4 j p arty Location — gdll ( - r , 1, II (Ji /4 S , T - N R E (o lb, - . r Property Owner's Mailing Address ■ e # Block # Subd. Name or CS r ,,Q I a �o�/j/f/ ' • • � � ST. CROIX COON: � � City Stale Zip Coda "( � �'� City ❑ Village Town Nearest Road . 1.fv,c9.So A t 1.5 VD.. ( 7 L )3 8L -91)(g. • Flatter b, a N 19- I 1 7O ti 51- • ❑ New Construct' n Use: Real enflal / Nu ber j f eed s CCode derived design flow rate _ /n —_ GPD .Replacement 5 j C G ` or S�I' D escrib • " 1 " /LT 5 - ~ - - -�� •• `� / — Parent material __ . Q.5._$. G U GY 6 ..iT tA.) .6 L. Flood Plain elevation if appiicabit _ fl. General comments t / Ica =ari 5 CC2 11a Q 4 T . 4 7 0 kip 0 d i . /rii.4.41,4m", My` 6 0 m ' Boring # 0 Boring q ® pit Ground surface elev. / � " ' ft. Depth to limiting factor /' in. Soil Application Rate • Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff . in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 2 / 9..4 !v1 R S. t- IFS b its nn tr c td t to • g a1- y8 /nYe. /9 , Se1 ants ,,,, 'r CiA i.) . 4 • to 's l..5 `t Rs / �, - FS 0-65 hwfr CtA.) — . S 1 • T> 5 ..% *HD 1 vlR$J - ,--- F5 a -S ii uVv- (— 1 s ■ a 1.1 , +91 Q � - f 4 i it Q Boring 6� a Boring # 97,16 lh to limiting factor 90 In. �• PH Ground surface elev. _ ft. Depth 9 Soil Air plication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence En +,niary Roots GFG /1f In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Etm2 MI! 10 o —° ads ,bvt. MOM a F INN s ME 7.StRy/f .GI..(9 1_Sbl • to EDAM I6`r# Ks/ F5 I Mil D all + V it • 11 M 3 "' ' Effluent #1 = BOD > 30 < 220 mg/L and TSS 30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS _< 30 mg/L CST Name (Please Print) Si nature ...'ST Number ....7 le ; en Evaluation Conducted Telephone Number . . • Property Owner Parcel ID 11 Page _ of .3 1 I Boring # ❑ Boring Q co Pit Ground surface elev. M y. � 0 ft. Depth to limiting factor /l) In. II lion Rate So App ca 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 t MEM 01k 1 En f".55 EMIN a F mrawil ' .fig 5 Y ' 9 .2.L d NS)" Ir p 1E111101111 3 yV 1, 4e. - --- ----- I a • S - MEMO /". . 1.0 4.1 ____ / 5 Lra 4 5 5 1 ' i I 1 Boring # ❑ Boring 1 ❑ Pil Ground surface elev. _ ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence I Boundary Roots GP0 /tf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 III 1 1. ... I Boring # ❑ Boring ❑ Pit Ground surface elev. _ ft. Depth to limiting factor In. Soil A..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 #t 'Eff#i2 IIWIIIIIIIIIMII Ellpill MEM 'Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent 112 = 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 zecess services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 - 8777 . .580-1130 (R.6N0) . i, Property Owner :C,n 14.), h ) C a Parcel ID / Page . _ of _3_ _ 3 Boring # ❑ Boring J (� T • ji.plt Ground surface elev. 98 ft. Depth to limiting factor Up In. Soil Application Rale 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 DID. : --- ___ a tin irall Q %'S 5y° y4y ..` j ____- _ f F MIMI 3 4 yD 1, per LIM p•$ - MEM t - • 1.07 rial sia 45 1 , I l Boring # ❑ Boring I ❑ pit Ground surface elev. ___ 11. Depth to limiting factor in. Soil .. dication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPC' /tf in. Munsell Qu, Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I I Boring # ❑ Boring ❑ Pil Ground surface elev. __ ft. Depth to limiting factor In. Soil A..Iication 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 'Etf#2 111111 11111 MEM 'Effluent #1 = BOD > 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. 5U0- !))0(0..6,00) , i i _ I - 5 LoYy .N W M I See r--A4 - '449N, 1 w ~ rI�.` f L.) — ... . f_ , r , ■ _, a ,, tt t (bert46110 1 - 1 5-4 -4 4r** -- one s ,,, L. Vi . r_ ... .. : 1 i r 10424 t , , _ it < , , i ` r Y` T1 , c...k, kbez, i, , . , , , LP. 11--1 1 1-- $ • , , %,.) %.01 , __!,,, =.' .. o - �_ , , 1 • . , $1081 r + Q ,), , . , , , , , ,, , , . . . . 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( ( ' • 1.7 ai 3 ( ' / / - 711 j. i ' AM& '' 1 / - , ti •,AL r #1Ik a g a/ 111 i s /-s— cc .) x x X i f z p c w ..9 c U `4 � , �ll � �� / / / = co �' ,, UJ � Lu X m °� \\ - 0 0_ LiJ O 1-. =2 _ J Z W m O � C7 O oTrE)-- c0 C Z i ( CO I / z = E- CO - -- 1■ ■11711 1) W o = o �� ,zo N 41 /7 .■ ,„/ / .., / ;----//,' ,- - 7). -.4. A , 41 • ' The Quick4 S ta ndard ber Cham INFILTRA syste Inc, as yr g . " h -• . :4111 , -\\:,,,, , ?,•74, \ ', , '7,to.„;;5,,,...,,,,z,,,,is,„44.-.7,4 AY+ n � r a a Tilt-- cluticrrary p tent pending ;Qu c 4� stall d rd C am ber fa �r . ' " v ti :n a i e� f cury d or straight systems, it .� feat a s the ° a tent p� Contour S,-,"..., v [ ertnection" which ' p ets; I t- dgree- t ? W r f rt left 1Te multi pith n€# cap a#!s 4. m � - te piper 'ppti +n e �+e n to rpe f tin s Th h r�r '; .=. . ' i . 3 : j f f`€xt l prpr�desirrf instar # #at+n fe ib� #�t}t. . . < The Quick4 Standard The MultiPort End Cap Offer Chamber Offers You These These Unique Benefits: �. Unique Benefits: • Pat - pend tear -out seals on inlet _ . •Advanced contourin connections port provide a tight fit to the pipe swivel 10-degrees, right or left •Eight molded in inlets /o utlets allow ��;•, ' • Latching mechanism allows for for maximum pipin flexibil quick installation •Multiple ports eliminate pipe fittings •Compact nesting provides more an mak loop ends easy trench length in an equivalent stack • Patent pending MultiPort end cap , . height fits on either end o the Quick4 4 Sta Chamber Four-foot chambers are easy to , A handle and install In is the number one septic 0. -" R ` � •The Quick4 Standard Chamber leachfield ch sy stem in the ' '. supports wheel loads of 16,000 Ibs/ onsite industry, with over 42 m il lion L . ; axle with only 12" of cover units in-' round in all 50 states and -� , . 24 countries. -, • Certified by the International „, Assoc iation of Plumbing and . - • ® ' W Mechanical Officials (IAPMO) Ap proved in •" g , • �• .. • 915919 BETH PABST REGISTER OF DEEDS s�; 1 HE RIFF,S ST . CROIX CO. , WI RECEIVED FOR RECORD Document Number SEED 05/11/2010 0 4 :3 0 PM SHERIFFS DEED • Drafted by: Duncan C. Delhe P EXEMPT # i a REC FEE: $11.00 Return to: Gray & Associates, - ' .L.P. ' (-" Attorneys at Law 16345 West Glendale Drives s' PAGES : 1 New Berlin WI 53151 * *The above recording information verifies that Berlin, this document has been electronically recorded • 'N and returned to the submitter. ** 018- 1034 -90 -000 Parcel Identification Number RE: US Bank National Association v. Nichole M. Wilson, Timothy A. Wilson, et. al., Case No. 09-CV-105 Pursuant to a judgment of foreclosure entered in this matter, the subject premises was sold at auction to the highest and best bidder, US Bank National Association, as Trustee for CSMC 2006 -7. Therefore, the sheriff does hereby grant and convey • unto said successful bidder, all of the following described land, located in the County of ST. CROIX, State of Wisconsin, to wit: W 363 feet of North 600 feet of Southwest Quarter of Northwest Quarter (SW 1/4 of NW 1/4) of Section Sixteen (16), Township Twenty -nine (29) North, Range Seventeen (17) West. SHERIFF - (Strike the inappropriate title) STATE OF WISCONSIN ) • )ss COUNTY OF St Croix) / ` Personally came before me this / d f day of , 2010, the above -named Atito a 101 A `UilL , personally known to me as the officer descr ed above, and who executed this document as the sheriff or on behalf of the sheriff of this county. _ Ps, \ II L I L 4' IA , Notary Public ST. CROIX County, Wisconsin w. � ` :``c di ., Flit My commission expires: 1 of 1 08/19/2010 15:27 IFAX Hudsonl;<ealtyFAX8CBBurnet.co■ HudsonRealtyFAX 001/401 Aug 02:19 PM St. Croix County Plan /Zoning 715 -386 -4686 1/1 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM • Owner/Buyer _ .er_ r ot. W: - e _ Mailing Address 13 01 Co oke e_ Q c • - •..so ta_. Sy0 t G, Property Address 9 1 f ?0' (Verification required from Months & Zoning Department for new ccn on.) City /State Parcel Identification Number O t ib3 -E LEGAL DESCRIP'I1ON Property Location SW y, , N LLl y, , Sec. 1 . , T _ ' NR OW, Town of h • Subdivision Plat: Lot # Certified Survey Map # Volume Page # Warranty Deed # �/5 ` Y / (before 2007)Valtune , Page # • Spec house yes • AD Lot lines identifiable ' yes ; no • SYSTEM M_dI CE ANA OWNER CRRTWICATIO 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 year or sooner, ifneeded, 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. 8332(1) and in Chapter 12 - St. Cmix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Depamnent a certification forms signed by the 4 owner and by a master plumber, journeyman plumber. restricted plumber or a licensed pumper venting 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 lees than 1/3 full of sludge. llwe, 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 Department of Natural Resource& State of Wisconsin. Certificc, lion stating that your septic system has been and:ea ed must be completed and returned to the St. Croix County Planning at Zoning Department within 30 days of the three year explration date. 1/we certify that all statements on thin form are true to the beat of my /our knowledge. Uwe amuse the owner( of property described above, by virtue of a warranty deed recorded ht Register of Deeds Office. (.4) Nu r of bedrooms wa, P SIGNA • . OF !' PLICANT(S) ,�n DATE /'Vfa "'Any Information that is misrepresented may result in the sanitary pemtit being revoked by the Panting & Zoning Deparbne nt '"*'r Include with this application a recorded warranty deed Prom the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05)