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HomeMy WebLinkAbout030-2145-10-000 Wisconsin Cppartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 514849 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Constantini, Edward & Suzanne I St. Joseph, Town of 030 - 2145 -10 -000 CST BM Elev: Insp. BM Elev: Descriptio Section/Town /Range /Map No: BM Q U Q b N `fin +- 1 c 1� ? k 30.30.19.3001 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchm /.35 . 3� /O6 v Dosing ) Alt. BM —?V o Aeration D `, b_ Bldg. Sewer � G /. Z• Holding J St/ t inlet �y 41 TANK SETBACK INFORMAT ON St/Ht Outlet C� tl� / TANK TO P/L 0,FL-L BLDG. Vent to Air Intake ROAD Dt Inlet / Septic bT /5 1 Dt Bo ttom Dosing > 25 � Header an. � ® fA �• Aeration Dist. ipe / , � �/ �• �� o / p�q Holding Bot. System Final Grade / PUMP /SIPHON INFORMATION Manufacturer Demand Stever r t S2 S 3 3 _ t,D 91 3 CJ GPM' Model Number q O 1, 3 TDH Lift Friction Lp S T H Ft z. Forcemain Le g v/ Dia. 2 „ Dist.ttoWell Lk SOIL ABSORPTION SYSTEM T BED /TRENCH Width Length �� No. Of Trenches PIT DIMENSIONS No, Of Pits Inside Dia. Liquid Depth DIMENSIONS / �J /� ,� SETBACK SYSTEM TO P/ BLD I WEL LAKEfSTRE A LEAC Manufacturer: INFORMATION C ER OR Type Of System: / / / UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution / p x Hole Size x ole Spacing I VenttoAir to / ", Pipes) / Length Dia Length I Dia / ' �J Spacing / �/ 2 - /61 ab l W ` ' SOIL C VER x Pressure Systems Only xx Moun Or At - Grade Systems Only Depth Over Depth Over m Depth of T xx Seeded /Sodded ed Bed /Trench Center Bed/Trench Edges Topsoil Yes 1:1 No E] Y COMMENTS: (Include code discrepencies, persons present, etc.) krspection #1: / 2 A / Inspection Location: 343 138th Ave WI 54082 (SE 1/4 NW 1/4 30 T�330N R19W) ''![ know - "n Wood Estates Lot 10 � Parcel No: 30.30.19.3001 1.) Alt BM Description = J "v C � �G S /° "� (� d ,/,� -L 2.) Bldg sewer length - amount of cover Plan revision Required? ❑ Yes o� if �'C 2 (� !j - Use other side for additional information 16 G _ Q� V�►� \ n ! to k < - -h Insepctor's Si e jJ `. faertlN SBD -6710 (R.3/97) •' 4 UUU r 1 U � - �/?i �� S `�� 1 � v r Q� J(d/�j _7L /1(�C�� -► coil' merce.wii.gov Safety and Buildings Division County 2011* Washington Ave., P Box 7162 / i sco n s i n Madison, WI 537 2 Sanitary Permit Number (to be filled in by Co.) Depwtme of Commerce s y Sanitary Permit Application State Tr Numb In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropri ove e / 5a 5 / 67 1 9 unit is required prior to obtaining a sanitary permit. Note: Application forms for state -own WT Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for ndary ses in accordance with the Privacy Law s. 15.04(l m Slats. ?Z/ � I. Application Information - Please Print All Information 0-7 PropertvADwner's Name REGE tarcel # Sinn �-�,:��•, lj3 - �,1� /S -ada Property Owner's maumg naoress APR 18 2008 operty Location d Z g ! 3 Lot City State Zip Code honeswipmOIXCOUNTY �' y,�� y,, Section ,310 ,� ak�f� MOJ � p�Z ZONING OFFICE (Chock One) H. Type of Building (check all that apply) Ott- a,p Lot # T3fN; R l 9 [] EAw 0 or 2 Family Dwelling - Number of Bedroo+ Z J /1 Subdivision Name ` f' , El /. Public /Commercial - Describe Use ao- F � � ��- City of ❑ State Owned - Describe Use CSM Number ❑ Village of Town of x - 75 A,J (�,_l I III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System Replacement Treatment/Holding Tank Replacement Only Other Modification to Existing System (explain) - - ---- -� System Permit Transfer to List Previous Permit Number and Date Issued B. Permit Permit Revision El Change of Renewal Before Plumber New Owner Expiration I I I - 1�: I � :�z ::�? ---- IV. Type of POWTS System/Component/Device: Check all that applyl o A_, r r Non - Pressurized In- Ground Pressurized In- Ground 0 At -Grade ound > 24 in. of suitable soil LJ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) Pretreatment Device (exTn) �- zz V. Dispersalfffrrmea tment Area Information: Design Flow (gpd) Design Soil Application Rate( sf) Dispersal Area Requir sf) Dispersal Area Pro sf) System Elevation S6 O i�z5 �J 2 1 A 3 9 , l,, VI. Tank Info Capacity in Total # of Manufacturer Material Gallons Gallons Units New Tanks Existing Tanks P lalz 525 Septic or Holding Tank Did /Qi e Dosing Chamber ) VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS s wn on the attached plans. Plu Name (Print) Plumber's Si ture RS Number Business Phone Number Lrd, Plumber's Address (Street, City, State, Zip Code) VIII. Coun /De artment Use pproved _ proved Permit Fee Date I ued Issuing t Signa er mon for Denial $ / too Z 2S - 6 IX. CoudiYy §Tk"W easons for Disapproval 3, Ai. 1. Septic tank, effluent filter and J 1 dispersal cell must all be services / maintained t°_c.A.awc as per management plan provided by plumber. C 1 fAe_`, l +-Q_ 2. All sftack requirements must be maintained p 910 pot Wl ttach to comp to p or a system and submit to the County only on paper not less than 8 112 z 11 iuehea m size SBD -6398 (R. 01/07) Valid thru 01/09 hey. — �iainar�� CliSernen� "boll % v EXiS F�nc /.'ne / E & /'S A ec/ c lei a-i ef ss �:��✓� G /erg - �ah.�scn Cons. ,%.o /O P /ar< � cd�d �= s�cc�eS SryS/rlcvey scc. 3a T.30/�,( /9 T. �rf S t So neP 4, fit. Croix C*., c.D /. (mil 03o- .zit's - /o -az� be, 3.13ac ,-,�3 Dralnay e 932. 2/' ,h �7, n �nz�ncto�Q �� J � �a,Se+na�.it s_ ��5;d er7 ce. � � `sue. s� �d. e. bui /d;r� Sew✓ I °� �° ' 275' Pff /LcrG/2 t� /t�a�STauZ` /�Z`. Q ° Proposed Xe -4 .2 ;r 9 75' � Y d•S�Cr.Sa /CP/ /. 5 iX�4,� aL,:J'F/'i �7w�r� -� �t�L�eit✓J lop 'l 3 6.75 - oril, - cep 'raace�at.2. /0 97.30' /9� ted %ss'i�ba a 16e �roer' 3(a /, gcs' ECOPY Center Connection Lateral Layout Diagram Force main connection via tee or cross to manifold at any point. Laterals are identical S T P s • = Turn -u p wf be I Iva Ive or 4I+X Laterals & force main of PVC Soh 40 cleanoutplug per COMM Table 84.30 -5 Holes drilled on the bottom of the later Number of Laterals 6 Orifice Diameter 0.125 in Lateral Diameter 1.25 in Orifice Spacing (X) 2.10 ft Lateral Length (P) 36.75 ft Orifices per Lateral 18 Lateral Spacing (S) 2.00 ft Orifice Density 4.17 ft /orifice Lateral Flow Rate 7.41 gpm Manifold Length 4.00 ft System Flow Rate 44.49 gpm Manifold Diameter 2.00 in Total Dynamic Head 18.63 ft Forcemain Velocity 4.54 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 Tank component is properly vented y �— Alternate outlet location Forcemain diameter Wieser Concrete Manufacturer 2 in. Cap acityl 646.00 Gallons Volume 17.00 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 20.29 344.96 B 2.00 34.00 C P ump off elevation (ft) C 4.71 80.04 � 89.92 D 11.00 187.00 D F - 1 Total 1 38.001 646.00 ' Do se tank elevation (ft) 3eg un er tank. 89.00 " Bddin Alarm Manuafacturer ILevelArm Alarm Model Number I DLV Pump Manufacturer JGoulds Pump Model Number I PE 51 Pump Must Deliver I 44.49 gpm at 18.63 ft TDH Project: Johnson Construction 3 bedroom residential mound Page 4 of 9 Safety and Buildings 3824 N CREEKSIDE LA commerce.wi.gov HOLMEN WI 54636 ■ TDD #: (608) 264 -8777 i sco n s i n www.commerce.wi.gov /sb/ www.wisconsin.gov Department of Commerce Jim Doyle, Governor Jack L. Fischer, A.I.A., Secretary April 03, 2008 CUST ID No. 227990 ATTIC POWTS Inspector WILLIAM C SCHUMAKER ZONING OFFICE SCHUMAKER PLUMBING ST CROIX COUNTY SPIA 1070 SCOTT RD 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/03/2010 Identification Numbers SITE: Transaction ID No. 1505168 Johnson Construction Site ID No. 734320 343 138TH Avenue Please refer to both identification numbers,_' Town of Saint Joseph above, in all correspondence with the agenc St Croix County SETA, NW1 /4, S30, T30N, R19W Lot: 10, Subdivision: Brown Wood Estates FOR: Description: Three Bedroom Mound System / New construction Object Type: POWTS Component Manual Regulated Object ID No.: 1169974 Maintenance required; 450 GPD Flow rate; 14 in Soil minimum depth to limiting factor from original gade; System(s): Mound Component Manual- Version 2.0, SBD- 10691 -P (N.0 1 /01), Pressure Distribution Component Manual- Version 2.0, SBD - 10706 -P (N.01 101); Commercial System The submittal described above has been reviewed for conformance with applicableWisconsin 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. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. 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 component manual(s) referenced above. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions ofSec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally down slope of the dispersal cell shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • Maintenance information must. be given to the owner of the tank explaining that periodic clewing of the effluent filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • A cony of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department which may include local inspectors P.O.W.T.S. Conditionally APPROVED DEPARTMENT OF COMMERCE ' WILLIAM C SCHUMAKER Page 2 4/3/2008 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s.Comm 83.54(1). • 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. • The owner is responsible for submitting a maintenance verification report acceptabb to the county for maintenance tracking purposes. Reports shall be'submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the rightto 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 Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789 -7892, Mon - Fri, 7:15 am - 4:00 pm WSMART code:, 7633 jen cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application G� IN DEX AND TITLE PAGE 1 N �` ,P , -Name: Johnson Construction 3 bedroom residential mound Owner's Name: Glen Johnson Construction Owner's Address: P.O. Box 890 Hudson, WI 54016 Site Address: 343 138th Ave. Legal Description: SE1 /4 NW1 /4, Sec.30, T.30N., R.19W. Township: St. Joseph County: St. Croix Subdivision Name: Brown Wood Estates Lot Number: 10 Block Number: Na Parcel I.D. Number. 030 - 2145 -10 -000 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Site Plan Page 9 Attached soil evaluation report Designer: Bill Schumaker License Number: 227990 Date: 01/14/08 Phone Number: (715) 386 -3121 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBDA0706 -P (N. 01/01) Version 5.1 (R. 06106) Page 1 of 9 u ..,......, yr .. .,..., .....__..._.. SEE C*RE P0NDENCE 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 8344.3 in - situ soft treatment for fecal 1.50 Peaking Factor (e.g. 1.5 =150 %) conform of <c: 36 inches. 450.00 Design Flow (gpd) 6.00 Site Slope (%) 97.30 Contour Line Elevation (ft) 14.00 Depth to Limiting Factor (in) 0.40 in -situ Soil Application Rate (gpd/fe) Distribution Cell Information 75.00 Dispersal Cell Length Along Contour (ft) 6.00 ell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/fe) t influent Wastewater Quality (1 or 2) Ar aterals the high�es# int _ - in the distribution ! T Press laribu Information network? Enter Y or N (C or E) 46 NUmiGe End Manifold Spacing (ft) If N above, enter the elevation ft r of Laterals of the highest point. 0.125 Orifice Diameter (in) 2.00 Estimated Orifice Spacing (ft) = 4.17 fe /orifice 2.00 Forcemain diameter (in) ID 60, orcemain length (ft) Does the forcemain drain back? Q _ 8T. 00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 9.79 Forcemain Drainback (gal) 2 � 9.72 Vertical Lift (ft) 44.96 5x Void Volume (gal) I 2.41 Friction Loss (ft) 54.75 Minimum Dose Volume (gal) 0.00 In -line Filter Loss (ft) 44.49 System Demand (gpm) 18.63 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia, options choice in. dia. options; choice 0.75 1.25 x x x 1.50 x 6� 1.25 x 2.00 x x / x 3.00 G� 2.00 x 3.00 x , �r ` Gallons/inch Calculator (optional) Treatment Tank Information !346.00 Total Tank Capacity (gal) 1oaa.00 Septic Tank Capacity (gal) 38.00 Total Working Liquid Depth (in) Wieser Concrete Manufacturer 17.00 gal/in (enter result in cell B49) 7 Dose Tank information Effluent filter Information (gib M 4 - Dose Tank Capacity (gal) Pol i4ok I f=ilter Mani. 7 Dose Tank Volume (galfin) PL -525 Filter Mode Wieser oncrets Manufacturer Project: Johnson Construction 3 bedroom residential mound Page 2 of Z00 ' IVAH a,LIS V UOS H a V V9LL SVZ STL Mound Plan and Cross Section Views 1 10 B Observation Pipe J . . . . . . . . . . W I i . —t . . ................. ....I......... .. I L Mound Component Dimensions � A A22.00 ft E 26.32 in H A7.84 ft O 11.29 ft B ft F 9.00 in 1 ft L 97.58 ft Q•�S A�'" D in G 0.50 ft J ft W 26.44 ft N „ 450.00 (fl?) Dispersal Cell Area P9.50 .82 (ft) Basal Area Available 6.00 (god /ft) Linear Loading Rate (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 100.88 (ft) ---► ttt ... G H ._„gym - 1 2 t�t�t�t . ��� F Dispersal C 99.63 (ft) Lateral 9� all 9 ,3_(ft) —► — Invert Dispersal Cell t Elevation E D .l ), ' i M1 ����. �y 7.30 (ft) Contour Elevation 6.0 % Site Slope Geotextile Fabric Cover Shading Key �. Dispersal Cell See lateral details on 1Q ® Topsoil Cap c 1.5 ft Page 4 for number, size, t:ttt, Subsoil Cap W 0 5 , •`;,• '•r�'ti . ti fti�: and spacing of laterals. R ASTM C33 Sand f ' ' •' ?'•:'r r•:•.• Laterals are ammHv Titled Layer d 0.5 ft `Typical Lateral ;, :r' F spaced Aggregate .r o 5 distribut •r; . : °'• centerlir — A -- distributior Project: Johnson Construction 3 bedroom residential mound Page 3 c Center Connection Lateral Layout Diagram Force main oormectlon ula tee or oross to mandold at ang point. Laterals are identical s { P r Turn %d bell valve or (E- x• -4KPJ2 02� Laterals & kxoe m,* of PYC . 40 aleanoutplu p per COMM "Fable 84.30 Holes drilled on the bottom or the lateral. Number of Laterals 2q' Orifice Diameter 0.125 in Lateral Diameter 1.0 in Orifice Spacing (X) Lateral Length (p) 36.75 Ottif*n per Lateral 18 Lateral Spacing (S) 2.00 ft Orifice Density 4,17 felorifice Lateral Flow Rate 7.41 gpm Manifold Length 4.00 ft� System Flow Fate 44.49 gpm Manifold Diameter 2.00 in Total Dynamic Head 18.83 ft Forcemain Velocity 4.54 ftlsec Dose Tank Information L � label and looking device and_ aesletl Watertight Eiectrir�l as per NEC 300 and -- ---iM► Comm 163.28 WAC DI � 4 in. min. Tank component is properly vented Altemate outlet location Forcemain diameter O Wieser Concrete nufacturer � 2 in. Ca ac' alto , Volume 17.0 gad nch A / Weep hole or or& Dimension I ches Gallons 8 siphon device A 21.78 370.25 8 2.00 34.00 C - P � ump o ff elevatian (ft) C ( 3.22 54.75 89.92 D 11.00 187.00 D Total 8 . 00 1 648.00 � pane took elevation (ft) 3" Bedding under tank Alarm Manuafacturer I LWv elArm Alarm Model Number I DLV - - Pump Manufacturer Goulds Pump Model Number IPE 51 Pump Must Deliver 44.49 gpm at 18.63 ft TDH Project Johnson Construction 3 bedroom residential mound Page 4 c C00 12] " IVA3 H,LIS V 1IOS a 0 V V9LL 86z S Mound System Maintenance and Operation Specifications Service Provider's Name Bill Schumaker Phone (715) 386 -3121 POWTS Regulator's Name St. Croix County Zoning Dep't. Phone (715),3,86-4 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 Wastewater Domestic Maximum Fecal Coliform >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 every 3 years 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 years 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 M6 -8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral g Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Johnson Construction 3 bedroom residential mound Page 5 of 9 • Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code Ge nera l 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), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD 10706 -P (N. 01/01)) 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 of in accordance with NR 113, Wis. Adm. Code. 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 filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent fitter alarms may indicate surge flows 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 next service needs to be performed 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) gn the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter 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 mg /L 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 if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation 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. Continaencv Plan If the septic tank or any of its components become defective the tank or component 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 repaired or replaced with a component of the same or equal performance. 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 piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 of 9 i 9 GOULDS PUMPS Submersible Effluent Pump PE tERVEHT PUMP SPECIFICATIONS MOTOR FEATURES Pump — General: General: ■ Corrosion resistant • Discharge: 1 NPT • Single phase construction. • Temperature: 104 0 F (40 °C) • 60 Hertz ■ Cast iron body. maximum, continuous when • 115 volts ■ Thermoplastic impeller ane fully submerged. • Built -in thermal overload pro- cover. • Solids handling: '/" tection with automatic reset. ■ Upper sleeve and lower maximum sphere. • Class B insulation. heavy duty ball bearing • Automatic models include a • Oil- filled design, construction. APPLICATIONS float switch. • High strength carbon steel ■ Motor is permanently Specially desicned for the • Manual models available. shaft. lubricated for extended • Pumping range: see PE31 Motor: service life. following • .33 HP, 3000 RPM ng uses: Ill Powered for continuous • Mound Sys ?ems performance chart or curve, • EffluenUDosing Systems PE31 Pump: • 12.0 Maximum amps operation. • Low Pressure Pipe Systems • Maximum capacity: 50 GPM • Shaded pole design ■ All ratings are within the • Basement Cra ring • Maximum head: 25' TDH PE41 Motor: working limits of the motor • • .40 HP, 3400 RPM Heavy Duty Sump/ PE41 Pump: ■ Quick disconnect power gth, d length, Dewaterinc; • Maximum capacity: 60 GPM • 7.5 Maximum amps heavy duty 16/3 cord, 20' standard len with • Maximum head: 29' TDH •PSC design NEMA 5 -15P, three prong, PE51 Pump: PE51 Motor: 115 volt grounding plug. • Maximum capacity: 70 GPM • .50 HP, 3400 RPM ■ Complete unit is heavy duty, • Maximum head: 37' TDH • 9.5 Maximum amps portable and compao METERS FEAT • PSC design ■ Mechanical seal is carbon, 40 ,. - , ceramic, BUNA and sta n ess PE51 MODELS: PE31, PE41, PE51, steel. HP: 33, .40, 50 ■ Stainless steel fasteners. o —► 2 GPM AGENCY LISTINGS 3C PE41 — 1 FT r. C ic p �1; PEAL_.._..,_ - 7,6,1 4 us c Tested to UL 778 and / CSA 22.2 108 Standards By Canadian Standards Association File #LR38549 Goulds Pumps is ISO 9001 Registered. ti I 0 10 20 30 40 50 607 0 GPM 80 0 5 1 15 m3ih Goulds P CAPA ITY 2002 m m oulds Pups ,p ,. /' ^_1B E?ie:uve NOVember, 2002 ' �9 a / "vr am �� � ` " PE 3 Y �� � ITT Indust S 7W? ?1 . ' / d � r APProX. loco- of lTei�� ✓irq de-ncL. c —c- Eli .Se, X- EXlS ��aq f�nec %rre / E /'S e�/ e isss daLo p� 935 " Gleri - �ok.�SC -n Ct�ns�• lam. # 0 3 c • .z i ys- /o -axe 6 e,� 3, /3 l6cre�$ 5r3.i� 17rnlna� e �.seme�� � Assumed e.lc✓' �� \ LY � r � �"4•u,r, �_ M �ro pos.e_d 3 bed /b0.r, ee siderl � 39' 97.3 ° �7 ® e) � � �/� a rOroPoscd rc�,�erCo>x,r�te. �i %' 9.16' Pff /Gc.�?�f " /r�v'a�s•T. act /�Z`. Q �- 'sc -h. SkJ P. ✓, C . {orcerrl c�: n . PI /ife-,7 d aE alp -'IV X 9 7 5 7.5 y d"3�e - -s Cell 5iX�la> a( "Jf/'i (7wLti'�n �4- L'�elt s ga pe of /'i 3 6.7 5 18 ar: /rce5 Aoaeec,�at /S' • 9730, /peq •eed /se "%e r o_-t4 16e CC, - ,Ie me C USpartmentof RECEIVED S EV LUATION REPORT Page of Division of safety and Builds d, (., 5 20 05 in accordance with m 8 , M. e Attach complete site plan papSrTn�t z 11 i s must County include, but not dmited to: rtical a nt (BM), directr Parcel I.D percent slope, scale or di arrow, and location and distance to nearest road. Q 3 of S Please print all information. R Date Personal Infomwtion you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). �Q Property Owner 61 �� Property Location (� ( 'U y � Govt. Lot S F 114 �'i;Uf /4 S T 30 N R jc7 E (or)0 Property OwneesMAng Address Lot # I Block # Subd. Name or CSIM C) . © 1 A rd u r) tu State Zip Code Phone Number ❑ City ❑ Village [Town Nearest Road Sv,'� i Sao 51 I-3 A.r , New Construction Use: Residential / Number of bedrooms Code derived design flow rate Z11 C1 d GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material _ ('� U `I C.c� S Flood Plain elevation If applicable ft. General comments andrecommendeftm 5y-4rlyl -e /-e.v , 7�7 9'6 f12u4- f"lAeioC 4 -0j Boring # B or i ng M 1(� 2—pit Ground surface elev. 1 ��✓ ft. Depth to limiting factor M. Sod Application Rate Horizon Depth Domment Color Redox Description Texture Structure Consistence Boundary Roots GPDff In. Munsed Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 L Z 1 -f . 7 -1V 0 — c_ Zrn m cs ( P fd S� _ nom; Boring # f LJ — t'it Ground surface elev ft. Depth to limiting factor L 4 in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDNf ( in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. f - Eff#1 'EfX2 ` a 9-14 1 1 — EI luent #1 a BOD > 30 1 220 mg/L and TSS >30 1150 mg& ' Effluent #2 = BOD 130 rrgt and TSS _< 30 mg/L CST Name (Frleeae ) nalrua CST Number Adder Date Evaluation Conducted T NUmber Men i 1 Y Property Owner b� Parcel ID # Page a of 0 ❑ 4-pit surface etev. q , ft. Depth to limiting factor in. SoN Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f!< In. Munseti Qu. Sz Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 i 6-9 C 1, —i — 3 8orh # ❑ Boring F ❑ Pit Ground surface OW. 1t. Depth to limiting factor In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDNF In. Munsell Qu. Sz Cont. Color Gr. Sz Sh. •Ef1#1 'Eff#2 E # ❑ Bodn ❑Pit Ground surface elev. R. Depth to limiting factor in. Soti Application Rate Horb= Depth DwkwtColm Redox Description. Texture Stru Consistence Boundary Roots GP Dff in. Mused Qu. Sz Copt Color Car. Sz. Sh. 'E11101 1 TRW • Effluent #1 a BOD, > 30 _< 220 mglL and TSS >30:E 150 mgll ' Effluent #2 = BOD, 1 30 mg& 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 alternate format, please contact the department at 608 -266 -3151 or TfY 608- 2648777. t v Property Owner �� /11f �i�i � � Parcel ID # Page of Boring # ❑ Boring EN 9-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 9 -1A _ F � # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor In. 91 icaft Rate Horizon Depth Dominant Color Redox Description Texture Structure Consists Boundary Roots GPDIff in. Munseff Qu. Sz Cont. Color Gr. Sz Sh. 'Eff#1 'Eff#2 E �9 # ❑ Ground surface elev. ft. Depth m limiting factor in. ❑ Pit Sop A pp li ca ti on Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GP QflF In. Munsel Qu. Sz Cont. Color Gr. Sz. Sh. 'Eff#1 'Elf#2 • Effluent #1 = BM, > 30 <_ 220 ffq& and TSS >30 150 rngll. ' Effluent #2 = SOD, 1 30 ffV& and TW < 30 nVL 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. SOMM as" PAGE OF NAME GM ri -so'n LOT# /� LEGAL DESCRIPTIONSF /a / a,S30 T 30 ,N � E(OR SCALE: I" BM I ELEVATION Alo- 0 N SM I DESCRIPTION Ino Z l &, BM 2 ELEVATION gg„gb BM 2 DESCRIPTION T SYSTEM ELEVATION SYSTEM TYPE QX 1 4 C� n 0 ,(� \ 7 SIGNATURE DATE we•.� oe� •e. / ♦.�►•.: .. . � .ewe. 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WAI '� ��'t _ _ _ e'�� ►' % ► o • . e w e w e w e o�e e e e w ► w e e ° e e we ''�w� ° -w -w- a -° -e- ewe--- - w -w-° ��C� e - '•.� • •� '?a� <v����e�e�eweweeiw�w9e` �Owewewewe�. Oe! e�ee�e�e�e�....... .... A�A�e.o�e�e�ev����e��♦ � • �.� -!!.A Ae O NE • „ I 411 66 3 , JOINT tn DRIVEWAY N EASEMENT b' 0% ° N 55.4702' WJ 63 LOT 1 142341 ,: HVE = 919:15 / �t�, 1f? � N 18'13'12' E: N p8 2O'39' E 216. 'Q' C 41 55.44' z ` � P �� 2�� LBO = 934:21 ''' c6 Co q `4' 11 59'58'52' E i Sp_...... 137 � , /fib e ft/ C, ® 55 06' �� �°' .. - ,��. 5 �7 °09, .- HwE 93z 2a 67 oT E � . ° n t3 N 30 21' w u l LN ® ° • 73' 158.0.' p¢ !7 p, CD COD •° � z gyp`! _ AA (� 102.90' v / D cjfc. L �P ,� 136214 S,F° o` HW = 929:76 3.13 Ac. ? LBO = 934.21 . C; ..... . .......... .. 1 210:72 361.45' 120 3 188.46 ` _.._......, __.., -_.._. -.. -_ S 89'57'01' W 549.91' N 00'42'55' E CR.A. S 89"46'21' W 550,06' 17,75' N 89.31 (R.A, N 00.58'41' E) UNPLAT �ry� COUn +`a Plitt t o Doc 813691 BROWN WOOD ESTATES LOCATED IN PART OF THE NORTHEAST 1/4 OF THE NORTHWEST 1/4, IN PART OF ReGISTG2•SOFRCe THE SOUTHEAST 1/4 OF THE NORTHWEST 1/4, AND IN PART OF THE SOUTHWEST ST. CRODC CO. WIS. 1/4 OF THE NORTHWEST 1/4, SECTION 30, TOWNSHIP 30 NORTH, RANGE 19 WEST, o TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN. l u',11 RPm-= I UN PLATTED LANDS L.,. s LOT 4 C.S.M. UNPLATTED_L — — — — /• cm scc u w VOL. 1 2 PG. 3255 S 8997'00' E NORTH 118E OF THE NORTHWEST T/4 t ¢a.n ♦1 W.Jt�T — —�/� 1444.09' S 89V7'00 09.07,00, 2509.50 AiUWM1Y uoNuN — — Nw EaR SEC ]0 3 70 ... 6524 - TO �1 66 416.40' 2 / W� LOT 2 ,.,. 3 R, LOT LOT 3 4 G4 /A w 'r 158724 6499 S p S.F. _ 1 13.F. / My,N /y 3.64 A�. / �4'0 ` • v 2 3.13 < T0p OrPI• a 59 c & s R, , s[3't,'55 W / oN N 9. eB 1 / N / Z _ / C E EV 8x3,•9' 4,,,E 2 O EASENENi r LOT 4 134816 S.F. / 3.09 Ac . / OI N 89'I5'50' V 247.46' .a R �. 4•v ] ® N 84. 38']1' V 424.8.' /, J =L O I LOT " I ® N 84. 38 1 31' V 4 ]1.95' Yfa �\ 139219 S.F. d T,• �� i I SOT 1 CSM 3.00 C. 9 A 33' zess EA$? F 25.9.28' ]3• 1e' j VOL. 19 PG. 4996 6' 6 LOT 5 r ,e- y IT 132281 S.F. Ac. o . _ n In ' [r r`I S zo = ,� _ z,+•E 902 n., [1 s o]o O to n y N 19'2 I t s Ir _ LOT 7 - N 51'42'14' E iq I \ 69.33' _ I58426 S.F. C �3 / 189'04'00' °. 3.64 Ac. \ 5.31' � ,.w - LOT 6 w u j 132409 S.F ` \% � m / N 00 E J 70.05_ / 4d = o J S 51 6933' V \ ® > 38TH oI AVENUE Cie 4 b p 3'. c Z J I ZI • �em _-- _ -__..J y f" o �9 q , 0 2 °b 5 932 / �„] y ,n � 1 6-1 m I n m y s 9 /�f ® ' - I w 5 LOT 13 k- �N 0 m� ,' 144188 S,F, LOT 12 LOT 8 cj L- " - LOT 14 3.31 A.. 130807 S.F. .lal ¢ S� x,, :, 31015 S.F. 157239 S.F. N 3.00 Ac. r� �'- 3.61 Ac. � NORTH DNE OF THE OJ 0 N 00'16 E SW 1/4 OF THE NWI /4 (/ \ IC I 69,79' = 1 ' �W"� y ® \ S 89.19'19' E 410.33' � �I� (NO ACCESS TO WEST) r 77131' 96.41' T'1 „.[ •'e2.,, _ CJ .101 N 89.26 V 067.72' Z` 3�?y „ ' °P 0_ (R.A, S 09'2!'43' E 06001') Mn 1 h /Tze 66 JOINT h 11 , \ �i 3 Ozz DRIVEWAY g5gE, Jl \ N e e), "J EASEMENT a 66, - 4 C)I 1 PRIVATE ROA ul �� _ 0 LOT 11 ry^ 06 9 � 66 — EASEMENT Q 142341 S.F. _ - OcENrER 1 Imo— RI 1 „ ��Ri� 3.27 zi„> •° y usEUENi r LEGEND ' 110T 9 0) PROPOSED DRIVEWAY LOCATIONS LOCATION MAP 80.1652 C 54T 09 1 .z .dz ? 1314175.F. B N 3.02 Ac. BUILDING SETBACKS (NOT TO SCALE o i;8 'yje zR '�r,�,` 2 M .,, ,• SECTION 30, T30N, RI9W1 NI > I z - w• - - -- DRAINAGE EASEMENT LINE w1 a h ) LOT 10 12' UTILITY EASEMENT Of N �"� V R 136214 S.F. q ° x N NE ¢ FOUND 1 1/4' REBAR .� t y 0_ 2N' 6 $$ SMALL a• • TRACT ■ FOUND 3/4' IRON PIN { o s _. 361.45' P 4 �n FOUND 1' IRON PIPE SW SE y — — — n,z 5 89'57'01 V 549.91' S 89 V 550.06) N ■ 17.7 1 5 .5, E N 89'31'!2' V 299.97' -� COUNTY SECTION CORNER FOUND AS NOTED I R.A. N 00.50'41' E) UNPLATTED LANDS LOT 1 LOT 2 LOT 3 — — — ■ SET 1 1/4 CENTER RUP W D BY 18 IRON PIN WT. 4.173 LBS. /FT. i30N RU P R VOL. 7, i . PG. 2052 i I w MONUMENT T SET 3/4' BY 18' IRON PIN WEIGHING HER NOTES: L O T OS PER LINEAR FOOT AT ALL OTHER f� 1 DRAINAGE •A SEMENT NOTE. LOT CORNERS. V IN6gp �EMlxas ARE RriERExcm 10 1NE NBRM urR: Dr THE NORINKST t • L HIGH WATER ELEVATION 5-21 _ 3O roMNSdP b Nd1m RMCE TR wEST ASMN[D ro _ _OE M NO OWMA di pE90FMT M1ALL DD MTNRIC RTRaI WPND „V[ UPa1A➢ = LOWEST BUILDING OPENING W1 & LLE J O o- x IX . 1 SUBSCT ro NNRC YFaAL A53E591EN15 ran ANY IENISPf MM d1 91ARx 1,E OPgATOrI a M NN'ROtm .eP WD NPROKNFNTS ro 111E ROAR. Ca1PREHOI9K WA1rA p1A11UTY ANO B0. Op9CR PIAR TOR 1145 ms Ixuuxs euT o nor uNTm ro NNaNO Iwo (RA) RECORDED AS SCAEE 1' 10 /71 AIO pO0.`R ALL ES 10 BF Ea1S1RUCtED N PROONIIr MM NMN WA1FA UiKli OBS11p C° AEIERIN4 iLLMD' °R IXCAVAmO OR RANTING N 30 NAA£ A TWIENEO {EdN OR WNDOW N[IL FLLYA1pN NOT IS94 TIM w Y EASFMExI£'WA1G MANAGE dRR[A WAIOI ROMWAYS. NET BUILDABLE AREA D DD aIX ca cn EET ARDK T E Ma WATR E SYA KN M OWN. " a K" x °E " °" a As: B mN� �/L r D dSTRNANCE ai u0PE3 xOR M GREATER NOT E EREO EoT S0. R. ACRES AN ME APPROKD PIAT 011 Ovl MAT IB IXCLUOEO AxNI MOT COKROI BY ME EBERM MONEY ARE PEMRRO ro MRY M MD REEOK A UTILITY EASEMENTS: nIBE , n "'I" SPFOAL F1tCEPTM P[PMIT. TI6 PERWT 5 MP IIE9 rM 5]ee z.19 EUM TIC W . ORIC[ MD IS REVIEMED 1NRWM A PUBLIC NEMIRD enss in"ocES.9 er THE sr. clap aauNrr eOARO ar AausTMErIT. AK x Pai M aMRD fMBIl9 ARE ro BE PuaIX ma mAr ,zzen B arr - ,ar (AEMC t3sa MEAwRm moM pop TH 111— TRMRS E e6rMEATM waAD SRNR Mr suRKY srARE, a z e� I ' �RONr - )6' C... ]YJ STREET NFA4NIm rlldl ROp IXs1U11BA1Ml afUR°c% ar�u¢ n ° vOI ulc n< 1 e �aeea, a.c /ry "� M . - zs• Ta a scrnaN sx.]z TRSwxaN sTAlurzs unurY 7 1x•ets ace - {-- IWI- •q--+' MoE zD' cASwExTS As rwaa s[r rollnl ARE rap mE usE a GENERA N STATE PVNK BOpIX AW MNA E M9NL u U [c AK O A B 043,7 1.93 RIMr ro BIXK ME AREA. 9zese z.0 10 98x8 ,.ga uws. AxIX .. PM R, MIORN roMNSNIP M ., uM (PIT) IS LU, WNTY. SUBiCT TB STATE. Reis Ara R uTwNS II.i KTDS, 9S. MCESS ro PM[[L Ero TME "REM PURMAWNO M 1 OF 2 McK""roiOMPI10 oMTM °aREOPMOU�'TO T ST- �Nn DRAFTED BY- BRIAN PERSON SHEET `N ianxc a"itaMM ARE r r rv% iru. . ! 1JJOOJltl J6�. YJJ tYJYJJ tYJ• JJPYI rc ST. CR O IX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSNfP CERTIFICATION FORM OwnerBuyer P, Mailing Address (�2 � (__An2 u d, c>_n ... t (C / ,. � 1 1� �•r S�� Property Address 3 4 3 1 (Verification required from Planting & Zoning Department for new seas on.) City /State �r) 4 L)'& ' arcel Identification Number — 00c) LEGAL DESCRIPTION �� 3� 0 Property Location !L IA , �• , Sec. , T _JLN R W, Town of f2L, ,OL Subdivision Lot # 10 Certified Survey Map t* _ ., , Volume .....____., Page # Warranty eed # �- U 1 _ ty , Volume , Page # Spec house yes 90 Lot lines identifiable yes no SYSTEM MAINTENA CE AND QWER CEHIJECATION Improper use and maintenaxe of your septic system could result to its premature faffi re to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a Hcanaod pumper, Wbat you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner maintenance respaostbilities arc specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. 111 prvperty uwiwr agro" to submit to St. Croix County Planning & 7onmg Department a certification form, signmt by the owner and by a toaster phimber, journeyman plumber, mstrictod plumber or s liconsed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after iaspmtiou sad pumping (if neeossary), the septic tank- is lea than 113 NO of sludge. I/wc, 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 Resources, State of Wisconsin• Cerfifkation stating that your septic system has been maintained must be completed and returned to the St. Croix County Planting dt Zoning Department within 30 days of the three year expiration date. l /we certify that all stateanents on this fomi are true to the beat of my /our knowledge. Uwe am/are the owner(A) of the property desoribod above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of b ms '-�_ SZNATURE OF APPLICANT(S) WA'I'F 'Any information that is rainepresentod may result in the sanitary pent» t being revoked by the Planning & Zoning Department. Include with this application a rocordod warranty deed from the Register of Deeds Office and a copy of the certified sur%'ey map if reference is made in the warranty deed. rV, _ 0 8 _ /0 __5)) 11111 Il 11111 11111 11111 11111 11111 1111 111111 1111 1111 * 8 5 4 4 0 9 2 854409 STATE BAR OF WISCONSIN FORM 1- 2000 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIX CO., WI RECEIVED FOR RECORD THIS DEED, made between Wendell Viebrock and Marcella Viebrock, 06/25/2007 02:OOPM Husband and Wife Grantor, and Edward Constantin and Suzanne WARRANTY DEED Constantini, husband and wife as survivorship marital property, Grantee. EXEMPT p Grantor, for a valuable consideration, conveys to Grantee the following REC FEE: 13.00 described real estate in St. Croix County, State of Wisconsin (the TRANS FEE: 426.00 " Property "): PAGES: 2 SEE ATTACHED EXHIBIT A Recording Area Name and Return Address: Land Title Inc. 1 00 5 Lakes P— Cl,' ETke N4wvv gvi8 o f c ", M N SS 112- #289651 Together with all appurtenant rights, title and interests. 030 - 2145 -10 -000 Parcel Identification Number (PIN) This is not homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except l�b Dated this 7th day of June, 2007. W y * Wendell Viebrock * Marcella Viebrock AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF MINNESOTA ) WASHINGTON COUNTY. ) ss. authenticated this 7th day of June, 2007 Personally came before me this 7th day of June, 2007 the above named Wendell Viebrock and Marcella Viebrock, * Husband and Wife to me known to be the person(s) who TITLE: MEMBER STATE BAR OF WISCONSIN executed the foregoing instrument and acknowledged the same. (If not, (� )4� I authorized by § 706.06, Wis. Stats.) nanya tiftdner THIS INSTRUMENT WAS DRAFTED BY Notary Public, State of Minnesota My commission is permanent. (If not, state expiration date: ) Larry Mountain, Attorney, 1900 Silver Lake Rd #200, New 01 -31 -2011 TANYA M. GARDNER Brighton, MN 55112 Y' ! ,l N (Signatures may be authenticated or acknowledged. Both are not necessary.) ottluy Public- Minnesota M otsfy on fix. Jan 31, la *Names of persons signing in any capacity must be typed or printed below their signature 1 of 2 WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1 -2000 EXHIBIT A Lot 10, Brown Wood Estates, Town of St. Joseph, St. Croix County, Wisconsin, 2 of 2