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026-1142-57-000
Wisconsin'DepartmNnt of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 429903 0 GENERAL INFORMATION (ATTACH TO PERMIT) $lle to Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)J. (qj ( = Permit Holder's Name: City Village X Township Parcel Tax No: Miller, Sam I Richmond Township 026- 1142 - 57-000 CST BM Elev: ( Insp. BM Ele : BM Description: Section/Town /Range /Map No: .O `(— �• �T �►� 25.30.18.1041 TANK 10ORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark O 1 w �c S �-- 000 . �-� cS Lf�• Dosing Alt. BM Cwt S b1L— Aeration Bldg. Sewer Holding St/Ht Inlet •�� 9�•�/ St/Ht Outlet TANK ETBACK INFORMATION $ •S �• q3 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet (•v 7 . Septic ' t 3 �! Dt Bottom Z+ r Dosing Header /M Aeration Dist. Pipe l02.3� Holding Bot. System PUMP /SIPHON INFORMATION Elul Grade tl 1 (L1w•(t6.t.aA 10 1 ParJW6 J Manufacturer Demand St Cover � •30 ,o�• Model Number 31- P7 r .; ,,,,, 1 1 L# �fb 1o3. }q 0 DH Lift Friction Loss System Head TDH Ft 0 0 % d 3• ZS ref• 6� , l e V Forcemain Length • Dia. Dist. to Well A, .3•p Z / Co. 9 SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of s PIT DIMENSIONS No. Of Pits Insi Dia. Li d Depth DIMENSIONS 10 tL1�S 1 SETBACK SYSTEM TO !! *jP/LBLDG T / WELL LAKE /STREAM LEA Manufacturer: INFORMATION CHA Type Of System: /� UNIT del Number: v DISTRIBUTION SY TE C Header /Manifold Distribution 1 t p x Hole Size It I x Hole Spacing Vent to Air Intake c am / Pipe(s) Z� r Q 0..1 ' , i 2 • St –3/16 Length Z •J" Di Length ` Dia Spacing 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 Bed/Trench Center Bed/Trench Edges Topsoil F Yes No =i Yes ^� � No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:" 1 Inspect ON: :/ Location: 1356 141st Street New Richmond, WI 54017 (SW 1/4 NW 1/4 25 T30N R18W) Red Pine corner 1st Additio Parcel No: 25.30.18.1041 1.) Alt BM Description= 5: �•"" " fir 2.) Bldg sewer length = 3( - annoti of cover = y 3 a No Pan r - -- -- -- - - - - -L _T vision Re cared? Yes Use other side for additional information. SBD -6710 (R.3/97) ` —= Insepctor s Signature Cert. No. i z Safety and Buildings Division County seons�n Madison, � � 201 W. Washington Ave., P.O. Box 7162 ST-- C Madison, Wt 53707 - 7162 Site Address De artment of Commerce 13 6 cl ]- Sanitary Permit Appl rs15.044(lft ) Sanitary Permit Number )qA In accord with Comm 83.21, Wis. Adm. Code, personal ' ED ❑Check if Revision may se be used for co Privac La I. Application Information - Please Print All Information AP 7 2003 Stn Plan I. N ber Property Owner's Name UiX C Parcel Number D26 — l 7 5 - 7 —0 00 <U I' 5 �4 •r► /y! /LL �or�Ew�� oFFic� - Property Owner's Mailing Address Property Location r / � y l /30)( 5UJ "•S /� a R City, State Zip Code Phone Number Lot Numbers- 7 Block Number __ Subdivision Name CSM Number v 4(.s 4 0 S V014 ? pr- 39r?- 4 '0 Z R ED Pf NE ecw m .r �(/ 73 / II. Type of Building (check all that apply) g ❑City �1 or 2 Family Dwelling - Number of Bedrooms - ❑Village ❑ Public/Commercial - DescribeUse wnshi L (1 Vt1 o n ❑ State Owned � G , / � S � X ?d ' �/ , 'S e 4 Nearest Road f jqf III. Type of Permit: (Check only one box on line A (numbering scheme for Internal use). Complete line B if applicable) A. I w New 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to For County use stem I I Tank Only I Existing System B. ❑ Check if sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numberIng scheme is for internal use) 44 ❑ Non - Pressurized In- Ground 21pq Mound *> Z� � S6, ( 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In -Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Trea ent Unit 49 ❑ Recirculating 3o ❑ Other V. ffiqwsalfrmatment Area Information: // 25 / Design Flow (gpd) Dispersal Area Dispersal Area Soil Appleadon Percpfitiod Rad System Elevation Final Grade Required Proposed Rate(Gals./Days/Sq.PL) (Min./Inch) r Elevation /a/.(00 `' rj � 6A--e- VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber plastic Gallons Gallons of Tanks� �6 a Concrete Constructed Glass New I Existing Tanks Tanks Septic or Holding Tank X - / 00 Dosing Chamber X ,�� / w •` wy VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MPIMPRS Number Business Phone Number � k.�. Vv�� �,,« t I )U� , VA-° Z. Z so 3 ( . Phunber's Address (Street, City, State, Zip Code) I o 7 c C-4 tp AV.1 vZ.T Is .0-- osv ( S O (41 VIII un /De artment Use Onl Approved ❑ Disapproved Surc Sani tary Fee) -32, Fee (includes Groundwater Date Issued ;Z77:i O ❑ Owner Given Initial Adverse )�� e _ / -7 n3 Determination v nditions of Ap roval/Reasons for Disapproval wl /'au0 /Lf dui h 7 i a� � T ,,, p x / ^ pigte plane (to the oolr) for the scat on paper not than El/2 :11 inches to swe SBD -6 3 (R. 05101) Top CF /0 SE�. E/ev 96.3o.' / Co E12, C 1,3 ��o. %Q(xS« on •�'� / G'rodc C le�a��or, . • / • /oca.��dP�ejo. ��'c /off 5 / � A Ol 7 A 83 c i elk t�-o�5ec1 nlo w / ,Z" Sc/�. y0 p�.c. 90' 'x al,s,p.e,-Sa/ Ce/% Jy 2 ,, x u41. 23' rb po s C.Q( 76D 9 , - Q. Or,F,�ps 6aa I� E p� rJe�n��o C- ltia.ner 6z lol ,o 303 ,O a 4�' /u "& /: ne propose.d ,, 0°o�y° P Sce eAC/uetiL "lam at oui /tt _ a � b u; ld,' Sewe%' Pr o pos<d V proposed w o l 3 b cdr co," dwelling a ^ 0 ,�a t Safety and Buildings 401 PILOT CT STE C WAUKESHA WI 53188 -2439 TDD #: (608) 264 -8777 *hSConsin www•commerc .wis ons Department of Commerce www.wisconsin.gov Scott McCallum, Governor Philip Edw. Albert, Secretary October 10, 2002 CUST ID No.225036 ATTN: POWTS Inspector MICHAEL P MC DONELL ZONING OFFICE MILLER CONSTRUCTION ST CROIX COUNTY SPIA 1070 HUNTER RIDGE RD 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/10/2004 Identification Numbers Transaction ID No. 793801 SITE• Site ID No. 651356 Sam Miller Please refer to both identification numbers,; Town of Richmond, 54017 above,: in all correspondence with the agency. St Croix County SW1 /4, NW1 /4, S25, T30N, R18W Lot: 57, Subdivision: Red Pine Corner FOR: Description: Mound, 3 Bedroom Object Type: POWT System Regulated Object ID No.: 873477 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10691 -P (N.01 /01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10706 -P (N.01 /01). In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner O must comply with the operation, maintenance and monitor; d as described in section VIII of the mound f / c pmponent m A copy of this information must be given to the owner upon completion of the project. 1� Maintenance information must be given to the owner of the tank explain that periodic cleaning of the filter required. Access to the filter for cleaning must be provided per Comm 84 product a rova con itions A Sanitary Permit must be obtained from the county where this project is located in accordance wen requirements of Sec. 145.135 and 145.19, Wis. Stats. O O7 ;`>q Inspection of the private sewage system installation is required. Arrangements for in on shat�, a ith the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis.a i � A copy of the approved plans, specifications and this letter shall be on -site during constructioi nd open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. MICHAEL P MC DONELL Page 2 10/10/02 In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Julia A Lewis- Osborne POWTS Reviewer 2, Integrated Services WiSMART code: 7633'' (262) 548 -8638, Fax: (262) 548 -8614 jlewis@commerce.state.wi.us cc: Leroy G Jansky, , Wastewater Specialist, (715) 726 -2544 I MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE RECEIVED Project Name: Sam Miller 3 bedroom residential mound ssytem OCT 17 2402 SAFETY $ BLDGS. DIV. Owner's Name: Sam Miller Owner's Address: P.O. Box 151 Trout Brook Road Hudson, WI 54016 131 Pcl. Add.: 4360 141st. Street Leal Description: SW1 /4NW1/4, Sec- 25, T.30N., R.18W. Township: Richmond County: St- Croix. Subdivision Name: Red Pine Corner Lot Number: 57 Block Number: na Parcel I.D. Number: 026- 1142 -57 -000 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Paqe 5 Svstem maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Site Plan Page 9 Soil Evaluation Report Designer: Mike Mc Donell License Number: 225036 Date: 09/12/02 Phone Number: - 715 - 386 -8692 Signature %c O Designed Pursuant to the Qas�9 d Q Mound Cmmnonent Manual fnr POWTS Version 2,0 SDR- 10691 - (N. 01101), and CI O SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) �y� Version 3.0 (03/01/01) Page 1 of 9 0 F � 2 C� F MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Sam Miller 3 bedroom residential mound ssytem RECEIVED Owners Name: Sam Miller SEP 1 9 ?flip? Owners Address: P.O. Box 151 Trout Brook Road S Fc7; z g, oar. c pp ✓.,I V. �1 J. Hudson, WI 54016 t 3S� Pcl. Add.: 436&141 st. Street Legal Description: SW1 /4NW1/4, Sec_ 25, T.30N_, R.18W. Township: Richmond County: St. Croix Subdivision Name: Red Pine Corner Lot Number: 57 Block Number: na Parcel I.D. Number: 026- 1142 -57 -000 Plan Transaction No.: Page 1 Index and title Paae 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Paste 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Site Plan Page 9 Soil Evaluation Report Designer: Mike Mc Donell License Number: 225036 Date: 09/12/02 Phone Number: 715 - 386 -8692 Signature: gih , Li, Designed Pursuant to Uhe Mound Component Manual for POWTS Version 2,0 SI)R 10691 -P (N: 01/01) and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) Version 3.0 (03/01101) Page 1 of 9 Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 83-44 -3 in -situ soil treatment for fecal 0 1.50 Peaking Factor (e.g. 1.5 = 150%) coliform of <= 36 inches. 450.00 Design Flow (gpd) 4.00 Site Slope ( %) 101.10 Contour Line Elevation (ft) 40.00 Depth to Limiting Factor (in) 0.40 In -situ Soil Application Rate (gpd/ft Distribution Cell Information 90.001 Dispersal Cell Length Along Contour (ft) = F77 5.00 Cell Width (ft) 1.001 Dispersal Cell Design Loading Rate (gpd /ft 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution information network? Enter Y or N (c or e) c Center or End Manifold 2.50 Lateral Spacing (ft) If N above, enter the elevation ft 4 Number of Laterals of the highest point. 0.188 Orifice Diameter (in) (e.g. 0.25) 3.00 Estimated Orifice Spacing (ft) = 7.50 ft /orifice 2.00 Forcemain Diameter (in) 40.00 Forcemain Length (ft) Does the forcemain drain back? Y 96.00 Pump Tank Elevation (ft) Enter Y or N 3.25 System Head (ft) x 1.3 6.52 Forcemain Drainback (gal) 5.10 Vertical Lift (ft) / 81.16 5x Void Volume (gal) Minimum Dose Volume al ' ion Loss ft 87.68 (gal) I 1.28 Friction ( ) 39.32 System Demand (g pm) 9.6 *Total Dynamic Head (ft) _ 9P Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 1.50 x x 1.25 x 2.00 x 1.50 x x 3.00 .7d 2.00 x 3.00 x Gallons /Inch Calculator (optional) Treat Tank Information 750.00 Total Tank Capacity (gal) 1000.001 Septic Tank Capacity (gal) 1 36.981 Total Working Liquid Depth (in) Wieser Concrete I Manufacturer 20.28 gal/in (enter result in cell B49) Dose Tank Information Effluent Filt In formation 750.00 Dose Tank Capacity (gal) lZabel Filter Manufacturer 20.28 Dose Tank Volume (gal /in) IA100 Filter Model Number Wieser Concrete Manufacturer Pa e2of 9 Project: Sam Miller 3 bedroom residential mound ssytem 9 Mound Plan View T • 1/10 B ; ; .• : Observation Pipe 0 _ j ---� •... ' K ti . .,...., ; ; . . ti . ti ..,.•... t ti . r�r', :r ;r %f:r'; r. • r; .r, r; r ;rtir ;fr, :r ;r,:•r• . ?: ?: A }: 'r ''rj � :r:? � r,•'r � :'; . 5 •;; f:r %r ? %r; r:r, r,•'r•r %r; ? %r •'r,.': %: :•. ti�•. tip. ti 1 L '. ti'L; ti•'• � ;�; •• •r; •r %r• •r; r; •r; •r %r• •r; r% •r %r•r r; r; r• ;r ;r•r ;r, •r; W : .......... : . .'.. .. ; . .. . ;.�.. ;; ;; ; ;. ;......... I ........... Mound Component Dimensions Down slop toe extension made. A 5.00 ft E 8.40 in H [ Ift ft K 7.18ft B 90.00 ft F 9.50 in 1 ft L 104.35 ft D 6.00 i G 0.50 ft J W 17.30 ft 450.00 (ft Dispersal Cell Area I - 1125.001 (ft Basal Area Available 5.00 (gpd /ft) Linear Loading Rate✓ 9.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 103.39 (ft) H 'Z F Dispersal Cell 102.10 ( Invert sir/ /r- (ft) Lateral 101.60 (ft) — 111 1 1 — : Dispersal Cell t Elevation E .. . .. ... '' . 4 ... �. 4 � 1 01.10 (ft) Contour Elevation 4.0 % Site Slope Geotextile Fabric Cover Shading Key m T Dispersal Cell See lateral details on Page 4 for number, 1.5 ft ti • .••. 01 Topsoil Cap o = ..r :, :r: } Subsoil Cap "' ° s •' �' ?•• �'r ;':: ?. size, and spacing of ASTM C33 Sand 1° `° f: •'� •• •r�r %r F laterals. Laterals are © v 0.5 ft :' Typical Lateral ,. Tilled Lay r �' ' equally s ® Y a q Y aced from p W :'.•':'�.'•�. Aggregate o •'rrr:� f�fer ;� ;r. '• the distribution cell's -- A --� -# centerline in the distribution cell (AxB). Project: Sam Miller 3 bedroom residential mound ssytem Page 3 of 9 Center Connection Lateral Layout Daigram Force main connection via tee or cross to manifold at any point. Laterals are identical —I F I P a AL r= Turn -up m ball valve or ;;<-X----3,.I+x;2 FW241 La terals & force main of PVC 5ch 40 el ea n out plug per COMM Table 84.30 -5 Holes diilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.188 in Lateral Diameter 1.50 in Orifice Spacing (X) 3.05 ft Lateral Length (P) 44.23 ft Orifices per Lateral 15 Lateral Spacing (S) 2.50 ft Orifice Density 7.50 ft /orifice Lateral Flow Rate 9.83 gpm Manifold Length 2.50 ft System Flow Rate 39.32 gpm Manifold Diameter 1.50 in Total Dynamic Head 9.63 ft Forcemain Velocity 4.02 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and Comm 16.28 WAC 4 in. min. Disconnect —�1– Tank component is properly vented L �— Alternate outlet location Forcemain diameter Wieser Concrete Manufacturer 2 in. GacaCity. 75000 T .. Volume 20.28 gal /inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 18.48 374.78 B 2.00 40.56 C P� um�off e levation (ft) C 4.50 91.30 97.00 D 12.00 243.36 D Total 1 36.981 750.00 iF Dose tank elevation (ft) 3" Beddina un er tank. 96.00 Alarm Manuafacturer LevelArm Alarm Model Number DLV Pump Manufacturer lZoeller —� Pump Model Number 198 Pump Must Deliver I 39.32 gpm at 9.63 ft TDH varir viitici ,.i u2u(OC3frl reside nlvLiirCj SSyi iii Page Of Mound System Maintenance and Operation Specifica Service Provider's Name Jim_T hompson #30021 Phone 715 - 248 -7767 POWTS Regulator's Name St. Croix County Zoning Dept. Phone 715- 386 -4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow -Average 300 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1000 gal Maximum TSS 150 mg /L Soil Absorption Component Size 450 ft' Maximum FOG 30 mg/L Type of Wastewaterl Domestic Maximum Fecal Coliforml >10E4 cfu/100 ML Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspect and clean at least once eve 3 vears Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Inspect for ponding and seepage once every 3 ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished • .............. ................ Grade 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Sam Miller 3 bedroom residential mound ssytem Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis, Adm. Code, and shall maintained in accordance with its' component manuals [SBD- 10691 -P (N.01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device, to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed din accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet fitter shall be assessed at least once every 3 years by inspection. The outlet fitter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the fitter when removed from its enclosure. If the finer is equipped with an alarm, the fitter shall be serviced if the alarm is activated continuously. Intermittent fitter alarms may indicate surge flays or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the need service needs to beperforrned to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the Minter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 rrvL BOD 30 mg/L TSS, 10 mg/L FOG, and 10' cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and 9 orifice cleaning is required to maintain equal distribution within the dispersal cell. Observatirr. pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan !t the s.rbc tank or any of Ls components become defective the tank or cornponent shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately , -r l ed With a co :. o •.ent of the same or equal perform, If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related ?:_ ;' ; i=-: fly Said CGT� ni3 S as �'e�� ?ed necessary to t}nr g tfnB SyStefri into pfQpE( Opera ing COndlt Qn. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Sam Miller 3 bedroom residential mound ssytem Page 6 of 9 HEAD /CAPACITY CURVE rn r • S W W W HEAD CAPACITY CURVE EFFLUENT MODELS - -. - I TOTAL DYNAMIC HEAD /CAPACITY PER MINUTE EFFLUENT AND DEWATERING —� SERIES 6749 97 90 1371]9 161 163 166 166 166 IM I09' FT M. a.L Lo-, ar Lis a.1 Ln a.. ltrs ar ut a.L La, I Lr.. 04 Ln. o.. Lit., as Lr.. ar In 1.62 43 163 66 212 72 .273 1 394 106 401 61 . 61 2J.1 69 220 166 667 156 $97 _ _ r 10 106 34 129 46 174 61 231 79 300 100 .179 61 231: 61 231 ba 220 144 660 IS 6771 — � - - i — 16 ..4.57 19 72 36 133 46 170. 64 242 91 U4 60 927 60 Z27 66 220 147 537 115 5W - 20 410 16 ''67 26 1 36 136 92 - :310 69 ?23 60 227 W 220 136 816 140 &W 26 7.62 - 9 30 74 260 67 216 69 72J 64 220 129 T 30 .. 0.14. 66 '246 66 .206" W 720 90 340 54 220 121 466 127 441 1 - --?. 40 1219 46 174 b 172 66 200 76 20 ba 227 106 397 114 431 t 186 60 16.24 - 21 :.� 33 126 61 191 W '.219. 66 230 90 341 100 an i 1i2D 16 67. 43 161, 36 136 64 210 71 YOD 45 3Z 165 - JO il/ 10 34 62 197 61 193 70 2661 60 24.39 14 W 45 170 26 106 5• 20. 90 27.43 - 100 3Q 48 _ 32 121 2 4 37 1471 ' j 163 Ito 3200 14 N 21 79j �J— 7 201 1 . w r Lak VaN.: 19.26' 2376 23' 26' 66' 66' 67' 73' 115' 91' 112 EFFLUENT & DEWATERING 165 Warning: Model 185 should not be subjected to less _ than 30 feet TDH. 189 Note: For Head Capacity on Model 112, industrial -- 161 column- explosion proof pump, see FM 219. 9 7 D: R• 188 98 - — 5 .55. 7.59 1 139 SEWAGE & DEWATERING LITER ,G 50 60 70 60 90 loo „0 1 7o I,o I.V l5o 160 WARNING: Model 293 should not be subjected LITERS ` )t„L �� 60 240 32C 4 1 t E ��560 640 to less than 15 feet TDH. a W 3932G r✓K;ncd+�d�„� s., IV r'ale r uil 4 24 60 7-- TOTAL DYNAMIC HEAD /CAPACITY PER MINUTE — 75 - -- — SEWAGE AND DEWATERING 22 -- ' -- -_.� T 1 1 SERIES 262 266 267 26a 262 264 292 293 2 — _ _ 295_ 70 —t_ l FT M Gal urs. Gal. urs. Gal Ltrs. Gal urs. Gal. Ltrs. Gar Urs. Gal, Lln G.1 Lr Gal urs _G U_ I 20 I _ 5 t 52 90 J41 128 484 126 484 128 484 130 492 18 681 140 530 19 ;4 2_ _2 6 52 — T 65 _ - - 1 0 3 05 6 0 227 8 3 89 337 69 3 37 95 360 158 598 124 469 _181 685 705 77 6 -_ IS 4 57 2 ? _5 65 50 189 50 189 30 189 63 238 135 511 106 401 130 492 165 625 185_ 18 60 20 6 10 _ - _10 38 10 38 10 38 33 125 106 401 68 373 119 450 150 5 88 168 6 3 6 — - 25 7.62 7 8 288 88 257 _ 106 401_ 136 5 1$ _153 Se ri_ 55 �— 40 12.19 43 163 47 178 _ 90 3 121 458 4L_ - 18 r 5 19 50 L62 94 356 u5 435 50 I S 24 — 50 --rt -- 60 18 . ?9 58 770 89 337 IJ 49 _ 59 14 � 70 21 34 223 IS Lotk Valve 78' 2t.5' 2 .5' 21.5' 26' 35' 42' S0' 6T 77 12 40 35 - — 10 I 30 g 293 25 6 -- 20 — 15 — — 4 282 - I i 2 -- - - -- -- 292 5 - -;— _ j 262 266, 267, 268 284 291 295 0 GALLONS 10 20 30 401 50 60 I 70 80 90 100 110 120 130 140 150 160 170 180 190 200 210 220 230 LITERS 0 80 16 f — -i- -.6 + - - - -�. I I r. —__�— _ __ _ 0 240 320 400 480 560 640 720 800 880 �. 7o9 Elea. z 96. 30.' .Cv /L � Do /3 � �� %GYxS�I'✓a�:on•a'� � . /oca..�tdP�6P. 4 57, A d A-111- C'err�er ,� BtrtCl. l ar Topo /ems 83 c � Propose.- rvta"O o `er /� z" :5U. N PV.C. /7 3O'X 35' 90' / / �iceVKA ;n. ol ,S,pt�S a/ C2 //. Our (y� i rbMIO 75Z ,9 -,.Q. ors / ces 5Pa ctd ot 3.0.-5, 100 QZ loi ,o 4 "A•s. T ni. 30311 Pale. /1"7e ly Pa posed 1, ��O �� �bt /,Q - /la ��lucrr� Pro past d 3 bcd�c�orr> Rro posed w ti I — 30 . ° a CL I I vi as 0 � Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 _of 3 Di tision of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x Ize. Plan must x include, but not limited to: vertical and horizontal ref qce ln . M), i and � R ) � Parcel I.D. percent slope, scale or dimensions, north arrow, and location End distance to nearest road. pending Please print all�lnforr»atr {¢[[''� Reviewed by Dale Personal information you provide may be used fo secondary purpbiP,�,j�aw, S. 15.04 (t) Property Owner Property ovation Oakwood Land Development I /' / r 70 �, o SW 1/4 NW 1/4 s 25 T 30 N R 18 2� (or) w Property Owner's Mailing Address ? Lo4%# Block # Subd. Name or CSM# COUNTY 1611 10 NE z �5 na Red Pine Corner City State Zip Code Phone Number ity ❑ Village ® Town Nearest Road Spring Lake k MN. 55 �2 612= /7$0 -49$(5�c Richmond 140th. st. ® New Construction Use: (Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material glacial drift Flood Plain elevation if applicable na. ft. General comments and recommendations: /01. (00 1 mound @ el 1 -1$.W. based on contour line of el. 101.10' Boring Boring ❑ # 1 g El pit Ground surface elev. 101 ' 90 ft. Depth to limiting factor 48 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 1 0 -12 10yr2/2 none L 2msbk mfr cs 2f .5 .8 2 12 -27 10yr4/4 none sicl 2msbk mfr qw if 4 3 27-371 75.yr4/4 none sl 2csbk mfr qw na ,5 ,9 4 37 -48 7.5yr4/4 none sl M na aw na .3 .5 5 48 -65 5yr4/4 c2d 75.ry5/6 scl M na na na .0 .2 a Boring # n Boring 101 .90 Pit Ground surface elev. ft. Depth to limiting factor 40 in. Soil Applicatio n 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 L 2msbk mfr CJw 2f 5 2 2 -20 10yr4/4 none sicl 2msbk mfr qw if 4 3 0 -40 7,5yr4/4 none sl 2csbk mfi 4 0 -66 5yr4/4 c2d 75.ry5/6 scl M na 5 6 -80 75.ry4/6 none sl 2csbk mfr na I Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mgA- Auent #2 = BO < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number Gar L. Steel 02298 Address a e Ev IuaGon nduded Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 8-8 -2001 715- 246 -6200 Property Owner Oakwood Land dh�/. Parcel ID # pending Page 2 of 3 F 3 Boring # 100.10 72 f ® Pit Ground surface elev. ft. Depth to limiting factor in. ' Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont Color Gr. Sz_ Sh. 'Eff#1 'Eff#2 1 0 -9 10yr3/3 none L 2msbk- mfr cs 2f .5 .8 2 9 -24 10 4/4 none scil 2msbk fmr qw 1f '4 " 6 3 24 -72 7.5ry4/6 none sl 2csbk mfr na na .5 .9 Boring # ❑ Boring ❑ Pit Ground surface Bleu. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont Color Gr. Sz_ Sh. 'Eff#1 'Eff#2 Boring # F] Boring F Ground surface elev. ft. Depth to limiting factor in. El pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture CaWstence Boundary Roots GLD In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOO, > 30 < 220 mg/L and TSS >30 < 150 mg/1- ' 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. S:B"330 OL&W> STEEL'S SOIL SERVICE 1554 200th Ave. Gory L. Steel Oakwood Land Dev. New Richmond, WI 54017 CSTM2298 SwT'NW'' s25- T30N -r , (715) 246 -6200 MPRSW -3254 town of Richmond lot #57 - Red Pine Corner This soil evaluation Was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines Were not established at the time the test Was conducted'. N 1 11 =40 1 BM.= top of mid 10t survey stake @ el. 100.00' alt. BM.= top of Sw lot stake @ el. 96.30' r� 6 < �'2 VE '� Gary L, steel 8 -8 -2001 J LT s - 7 , � '3,5 • (�l sT S T/L� ET" / a r T@ wn To, go eF 1 at 3TA K,.k- 5•-� Sf ��,` �) :: �o! . Gds J c.9 � z � l N'� � u� Jp7 Z � 9� o0 o e t = i oo• �, 7So -CA L sr so- I 0 6s' Zs . v a � y /ts• t I _--- -- 1 k,consin Department of Commerce SOIL EVALUATION REPORT Page 1 _ of 3 sion of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Coun Attach complete site plan on paper not less than 8 1/2 x I �e. Plan must Croi P elude, b Pnot limited to: vertical and horizontal ref nc�e Ipoin . M�' V(rgction and Parcel LD dZt'O � � percent slope, scale or dimensions, north arrow, oc3tte d tn and distance to nearest road. n Please print all nformati R sewed by Da AA Personal information you provide may be used tor'secoridary purpUCIF i aw, s. 15.04 (1) (m)). ` / / ( Vjg U Property Owner Property ovation Oakwood Land Development jGovt._L. SW 1/4 NW 1/4 s 25 T 30 N R 18 K(or) w Property Owner's Mailing Address COUNTY Lot q Block # Subd. Name or CSM# 1611 HY 10 NE Z �7 na Red Pine Corner City State Zip Code Phone Number ity ❑ Village ® Town Nearest Road Spring Lake park MN. 552 �, Richmond I 140th. st. ® New Construction Use: EX Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ❑ Replacement • ❑ Public or commercial - Describe: Parent material glacial drift Flood Plain elevation if applicable na ft• General comments and recommendations: mound @ el. 110.60', based on contour line of el. 101.10' ❑ Boring # 11 Boring 101 .90 48 1 El pi( Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ffl in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 I 'Eff#2 1 0 -12 10yr2/2 none L 2msbk mfr cs 2f .5 .8 2 12 -27 10yr4/4 none sicl 2msbk mfr qw 1f 4 3 27 -37 75.yr4/4 none sl 2csbk mfr 9W na .5 .9 4 37 -48 7.5yr4/4 none sl M na na 1 .3 .5 48 -65 5yr4/4 c2d 75.ry5/6 scl M na na •0 .2 �2 F Boring # F] Boring LX Pit Ground surface elev. 10 1 • ft. Depth to limiting factor 40 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 L 2msbk mfr qw 2f .5 2 2 -20 10y none sicl 2msbk mfr qw if 4 3 0 -40 7.5yr4/4 none sl 2csbk mfi aw i 0 -66 5yr4/4 c2d 75.ry5/6 scl M na 5 6 -80 75.ry4/6 none sl 2csbk mfr na I Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg /L uent #2 = BO Q ,: < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature . CST Number Gary L. Steel 02298 Address Da a Ev uation CAducted Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 8-8-2001 715- 246 -6200 Property Owner Oakwood Land dEv. Parcel ID # pen d i ng Page 2 of 3 F Boring # ❑ Boring 3 ® Pit Ground surface elev. 100.10 ft. Depth to limiting factor 72 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlff in. Munsell Qu. Sz. Cont: Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 1 0 -9 10yr3/3 none L 2msbk mfr cs 2f .8 2 9 -24 10 4/4 none scil 2msbk fmr 9L&I 1f 4 6 3 24 -72 7.5ry4/6 none sl 2csbk mfr na na .9 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 GPDtfP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F Boring # F1 Boring Ground surface elev. ft. Depth to limiting factor in. 11 Pit Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlfF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30:S 220 mglL and TSS >30 < 150 mglL ' Effluent #2 = BOD < 30 niglL and TSS < 30 mg1L 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. SBD -8330 (RAM) STEEL'S SOIL SERVICE Gary L. Steel Oakwood Land Dev. 1554.200 #h Ave. CSTM2298 SW'NW' s25- T30N -r18W New Richmond, WI 54017 MPRSW -3254 town of Richmond (715) 246 -6200 lot #57 -Red Pine. Corner This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test vas conducted. N 1" =40' BM.= top of mid 10t survey stake @ el. 100.00' alt. BM.= top of SW lot stake @ el..96.30' C� d x ' %? Gary . steel 8 -8 -2001 Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at.the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number D Number of Bedrooms Design Flow - Peak (gpd) O Estimated Flow - Average (gpd) 3 00 Septic Tank Capacity (gal) Soil Absorption Component Size (ft Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) - Maximum Influent Particle Size (in) 1/ Maximum BOD (m /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the i _ - Management Plan for a So-ptic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage e from the system is prohibited and considered a human health hazard. A- Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense and earlier, organic clogging of the soil. 9 9g 9 2 i Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep- rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. a � f Stl CI % K V k? Y G i N ;�� s- 3 Y 4- y G ga 3 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHM CERTIFICATION FORM Owner/Buyer f? �1 ; /m✓ Mailing Address' f3 o de � 1� s o •� U J i J� i Property Address (Verification required from Planning Department for new construction) City/State go, Parcel Identification Number c> 2 4 - 1a Z - q s moo �F.(:Ai. DESCRIPTION . Property Location S_ Q . '/•, c '/•, Sec. Zs' . T - 2' 0 N own of Subdivision a— Cb r Q �' � Lot # i Certified Survey Map # / 7331 . Volume —• Page It - Z , Pa e# �z7 Warranty Deed # . Volume g Spec house 0 yes ❑ no Lot lines identifiable qf yes O no i �eve M MAi1�iTEN Improper use and main tenance of your septic system could result in its premature failure to handle wastes. p into consists of pumping out the septic tank every throe years or sooner, if needed by a licensed Pumper- What YOU Put can affect the fiction of the septic tank as a treatment stage in the waste disposal system- ' Department a certification form, signed by the owner and by a T� property owner agrees to submit to St. Croix Zoning Deparlm masttxplumber, joumeymanP lumber, restricted plumber or a licensed pumper ve rifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the se pti c teak is less than 1/3 full of sludge. and agree to maintain the private sewage disposal system with the standards I/we, the undersigned have read the above requirements t of Natural Resources, State of Wisconsin. Certification set forth, herein, as set by the Department of Commerce and the Departmen Offi within 30 stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning days A the three year expiration date. f (;� � Y A& ' OF PLICANT DATE OWNER CERTIFI N knowledge. I (we) am (are) the owner(s) of I (we) certify that all statements on this form are true to the best of my (our) the roperty 'bed a ve, by virtue of a warranty deed recorded in Register of Deeds Office. / 03 >, C3NA OF AP LICANT f DATE . Departnien b the Zoning ning re mis- led may result is the sanitary permit being Y assess lion that is Any informs np Register of Deeds office • a warranty deed from the Reg «s Include with this appUcatlon. :tamped tY re ference is made in the warranty deed a copy of the certified survey map if re I J 2203P 127 716881 STATE BAR OF WISCONSIN FORM 1 —1998 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI Document Number RECEIVED FOR RECORD This Deed, made between Oakwood Land Development. a 04/11/2003 09:00AN Corporation , Grantor, and Sam E. Miller, a single person Grantee. WARRANTY DEED Grantor, for a valuable consideration conveys to Grantee the following EXEMPT # ' described real estate in St. Croix County State of Wisconsin (the "Property "): REC FEE: 11.00 TRANS FEE: 200.40 COPY FEE: CC FEE: PAGES: 1 Recording Area Name and Return Address Sam E. Miller P.O. Box 151 Hudson, WI 54016 026 1072 95 000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Lot 56 an 57, Red Pine Corner 1st Together wl nghts, title and interests. none Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except Dated this 2nd day of April 2003. (SEAL) (SEAL) � n Oakwood Lad ev m t (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, } ss. Y UBl.IC St. Croix County authenticated , STATE OF WISCONSIN Personally came before me this 2nd day of April 2003 the above named Gregory J. Peterson as Vice President to me known to be the person who ex#Puted the foregoing TITLE: MEMBER STATE BAR OF WISCONSIN ins ment d acknowledge thy same (If not, --- authorized by §706.06, Wis. Slats) L J Z n� THIS INSTRUMENT WAS DRAFTED BY Notary Public, State 0 Wisconsin Coidwell Banker Burnet 1301 Coulee Road My commission is permanent. (If not, state expiration date: Hudson, WI 54016 2 J�) SJb l -41085 h�� 11 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) Names of persons si nin in any cae acity must be ed or Erinted below their si nature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co, Inc. WARRANTY DEED FORM No. 1 — 1998 Milwaukee, Wis. F A .� \ bh °° LOT 53 `��� // V > ``, \ p \ \ `�q, 66,000 $a fr ; e- IN 1.52 ACRES l 13 9 S89`55'01 "E 296.44' / \.55 . ,!� i I 6 > 7 �' ko yo ♦� 103.2 19 3.t2' s `N 9'0 : ��t� S8'4 gES / 6 ` ` 02 "E tiR90 '. \ � j3 "E lss'oi • LOT I N . 51 8 NKIas \ / "LOT OT 52 y 66,E so. rr o ` I - l _0 T 10 O ` °� i /' 64642 •sp, F7 ,� 'j �f CR£s OO �\ ` ,j�� S `X . 1.58 AQ4E$ , -l` / -/ / / I O ✓� 7 ''. h'� ��P �` NB9'55'01 -w I� •,����\` Ate �OQ� PLO 278.89' I (r+ `\``� 7 ' \ � j / � ,yC' LOT 50 I y r , i �'• ` 11 18 ` ` �O 65, 40s So fT, i � cn � LOT 54. 1 1.50 ACRES ," F \ 640019 1. 5? A07E 1 \ i\ S 3 d �, `\ i ` N80'45'22 E h c� . , ; ` 378.11' ki r Jc LOT 49 I g I LOT 55 ' 1 0 s2 e4J sb f r 1 1 I 1 6 66, 6JJ SO F7 1 • 44 A i 11 CR£S 45J ACRES p � I \ \ \ _ .. _ .. _ _ • !,1 -.•' r1c I N89' 3'43 "w • 344.70' N N s, • f `V 230.79' S 11 3.91' N89'53' " a a 43 `�- cIV 1 , LOT 56 N � 67 ?34 SG. fT v°j 00 clq ,.SS ? ACRES .. h LOT ,fi 4 e '` / h i 8 O h •� / ^ , 71, 696 $0. cT n tr ^, 3 ry e 1.65 A04ES N , 3 N >j 0$ ^ry c ` \ \v, P LOT 57 i 'O % N79 74'Sy w O 66,975 $a Fr i j w O� i 303,33. 1.54 ACRES i i L iiJ x- 'I - •._.. ! I , . _ LOT 47 N W - O 9'¢ „ I i i i 731047 2 W '3 �w 8O• J.7 ?ASS N 3 �'. LOT 35 �, 1 g 3 s /5! 3 N13 "W . 1 - �e ' o 0 , ` $, 1 - - - - -- N � \ ' 73.73.. " 35 33 ' -- .__..___'_`'�N � V) ' a8b'�S,w o f �\ 9 20 � 3(v AYE \, _ _N S2Z 9 1 0. 1137 66 W t1 -- 741 .................................... ez_ IL 9 g � Gi3