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HomeMy WebLinkAbout030-2131-03-000 0 7? r IN 0 / 6 a 2 k ID ° f � ■ O 0 -- z o 2 ° ° 2 Z [ 7 m U) = � \ o r') :3 k (D 2 7 ( ƒ ! 2 \ § ° 2 � , , ! 8 ƒ G 77 / \ t ■ -4 D E F n ) @ ƒ (A) , =r © � o � C -O [ / Z > ¢ + i \ \ r2{� ® & §] / c o ¥' n r @ . 0 \ § § ' 0 0 0 o $ 0 0 0 2 � } 0 f cc §) § § \ 7 E § \ \ 0 ] .. c E z k . § / 5 4 § I 9@ w � i A \ , n 0 3 \ k k \ } [ k / z E i [ � R a ■ � ( / / E § / z § F = § 7 ƒ 2 » � E ; ^ � . =z0 0) m, > EE§E o � \[ Co iE+\CL § CD mweo o (n i ( 17 "J \,zz $ $ E n a' CD $ ; \3000) -- CD 3 m030o 4 . COD' §+ 2 ���£,00 \ E /kn acn a 8E o . © § CD g �- mR i %0 km& �E 7 F 3 ( 2 5F 7 / 2 E \ � CD 0 � k r - - Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 453182 0 GENERAL INFORMATION (ATTArH TCqFRMIT) 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: St Joseph Dev Corp St. Joseph Township 030- 2131 -03 -000 CST BM Elev: Insp. BM Elev: BM Descriptio2: Section/Town /Range /Map No: S") S — f3 23.30.20.1057 TANK INFORMATION ELEVA ON DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ' 2 5-D Benchmark s Fri I.T. Closing ( I T V �P/YS h'L w� Alt. BM ��� 1 A-,U ¢_ J b 24 ✓ o n Aeration 0� B ldg. Se wer 63 M1 D 16 Holding Ht Inlet 1 J 2. V� YS �p'Z� TANK SETBACK INFORMATION St/Ht Outlet 30 ::3 3 • / 9� d TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet pl G Septic I 3� / (Jh Dt Bottom / pn Dosing U ead r/ an. Aeration Dist. Pipe 6� ern 3 - Is Iq Z. Holding Bot. System Cl - L. Final Grade (/�. PUMP /SIPHON INFORMATION G6� � 3P I ' c l 7 ' Manufactur r Demand St Cover 2 Model Number TDH Lift Friction Loss s em Head TDH Ft Farcemain Len- Dia. Dist. to Well T t �Ys - - SOIL ABSORPTION SYSTEM oZ ( &g — . dtl 4 64h 61 -d- BED /TRENCH Width 3 I Length t No. Of Trenches PIT DIMENSIONS No. 6f Pits Inside Dia. r Liquid Depth DIMENSIONS _ 1 _ SETBACK SYSTEM TO P/L LD 4 — LAKE /STREAM LEACHING Ma ct y // INFORMATION C HAMBER O R { TyU✓ Ty Of System: � - 7a 1 UNIT Model Number: DSO �� DISTRIBUTION SYSTEM z*_ j HeajxA4enifoId I Ditribution s L, x Hole Size x Hole Spacing TVen�tto Air Intake V d Pi Pe(s) >_ may' Length Di a Length I n Dia Spacing r (/YT 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 Yes No 1 Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: �u1 _10 / Inspection #2: Location: 138 Heritage Tr Unknown (NW 1/4 SE 1/4 23 T30N R20W) Settler's Glen Lot 3 Parcel No: 23.30.20.1057 1.) Alt BM Description = ma"I � a /e- 79 2 sA, V�fil�l 2.) Bldg Sewer length = I - O� SRir]d Imo. yyt Icy JyS� Pis'► - amount of cover = 1 Plan �r - �t C�'tGiw✓la.P�YS DO `f• 8 S'� °J`� Use other l s de for additional information. o �_� SBD -6710 (R.3/97) Date Insepctor's ignature Cert. No i -XI 07 - 4 l � dD s�r � I ' Pj co pl � J W - 1 JL r 1 i \ i i 1 i Saroq and Suildings Ui - .ur 1 c c:uniy 241 W. Washington Ave ; F Ya Madison, Wl 53707 Sanitary Permit Number (to be filed in by Co ) Department of Commerce (tee) 265.3IS1 3 1 92— Sanitary Permit Application State hu 1.D. N4rtilw In scrord with Comm 83.21, Wls, Adm, Code, perhonat information you provide may be used for secondary purpose Privacy LaAO ti Project Address (if different than ntailaill address) 1. Application Information - Pisaa. Print All Worm ation f 3 g Agf- M4G6- Property Owner's Na mis 704 F reel I Lot # Block ZEL 5 11 e Praparry Owner's M ailing Address I ' i=� r. { 0 OFFICE i Proper ation S City, State Zip Code Phone Number -�•- -- �C at/ 5 Q Z C 5"! X37 T X34 N; R ge _$ o ) II. Type of Building (cheek all that Apply) l Of 2 Fatally Dwelling - Nwttber of Bo&OM s Subdivision Name C M htunber ❑ Public /Cornmarcial - Describe Use r c (� ,� G 1f�� S' / ✓a +�.� Q State Owned - Describe We ❑City LVillage 0,01 - wnship of III. Type of Permits (Cback only one box on Una A. Complete Una 9 applicable p 30 -- Z ( 3 o 54 A" , New System ❑ Ra0scement System ❑ Trsarrnent/liatding Tank Roplacement On!y 0 Other Modification to Existing System B, ❑ Peftnit Renewal C Permit Revision C Change of Permit Transfer to Now i List PrevWua Permit Number and Dace issues Before Expiration Plumber Owner j i IV. Tyfle of POWTS Syetetnt L% ck all that apply) _ I )jr.-400 - Pressurized In-Ground r] Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ M-Grade A Single Pas Sand Filter I Q Constructed Wetland [ Pressurized In- flround ❑ Holding Tank C Peat Filter C Aerobic Treatment Unit ❑ Recirculating Sand Filter L R*;lrqul&Wm S nthetic Media Filter Leachin Chamber G' Li LS G vebiess Pie ❑Other (exp lain) V • 1 Area InforthWon: n, Dulgn Flow (gpd) Design Soll Application Rste(gpdst i Diapersai A Re (s6 Dispersal Area Proposed - t* yssem Elevation ,�► , ? �� jai Af VI. Tank Into Capacity in ToW Number j Marufacr.rer Prefab Site - Steel rriber _ Pleader; Gallons Gallons of Units i Concrete Consavcted Glass i N ow ! T Tanks Existi SWis or bolding Tank _. Aerobk teatmertt Clt � Dosins / VII. Resporilbillity Statermt- I, , 6"un a res pon"illty for inrtoliatlon o t he POWTS shown on the a ttaehedpLas. Plumber's iota me (Print) Plumber's Si ariature TMPIhtPRS Number Business Phone Numbst Plumber's AM* as S ( a'set. City, Slue, Zip Cadet �- Q VIII, Couint /De l rtaleat Use Ow Appreivgd Q Disapproved Sanitary Permit F" includes Fev) G ❑ Owner Aea roundwater Rate Issued I su g Agent Signs. ('tie Stamps) � Surcharge 2� — t3iven son for Denial W (� i IX C�onditlane of Approvah eYOng for Disapproval SYSTEM OWNER: 3 `(3�'^^ w U 5. d 1 Septic tank, effluent filter and So "� � . Do r � -Qatar � At-a' dispersal cell must all be serviced / maintained -- I as per management plan provided by plumber, ti o e {' cdx" w 2. All setback requirements must be maintained as per applicable code /ordinances eompiaw Ito die Ceeaty ody) for the system on paper not %" thra $!/= x it " u CRTI- i4ZA1t fu m Ina) r #- of Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings c in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must ` 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. .30 --- �� R Date Please print all inf ° ' : ^� Personal infom�ation you provide maybe used for ary ses (Privacy Law. s. 15.4 (1) (m)). ��(�✓� J Z Property Owner s rope Location " �` Z3 30 Vt. t !� (,k, 1/4.� 1/4 S T N R E (or W Property Owner's Mailing Addres r Lot # Block # Subd. Name or CSM# Z© Segle s /.e Ci State Zap Code ! Plh u r ❑ City villa a Town Nearest Road �] New Construction Use: Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement �o ❑ Public or commercial - Describe: V ( 1� W S A Flood Plain elevation if applicable Parent material r General comments y /Q wj V . k"'a 'q 3 aU GUxv er 9/ coo and recommendations- 2,1 //O Y Boling # Boring ® pit Ground surface face elev. 9 3 b0 fL Depth to limiting factor 1 34 .-in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. ConL Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 I O-2- A0 r2 S( - 1 2a-)c rf - �Vr IN rgij `^ Yr� r c� — . 5 • S I VV Boring # Boring ® Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftt in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efi#1 I 'E02 2mc� m�' cs v 2 $ 10 - K 4H — 5 i l 3 -i L y Lt.o ccE t' ro t ' � ��' 7i " ✓VG'S- YU.Q�t♦ 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 allure / CST Number S�tivr,r r 253 - Date Evaluation Conducted Tel phone Number `' 3 S �Tb r erSE � S�OZ S /� �� (7l �� ZF-7 -L10nS Property Owner Parcel ID # 3 �BorV Page � of El Boring #• ❑ g ❑ Pit Ground surface, elev. .�s.1� Depth to limiting factor In. Horizon Depth Dominant Color Redox Description — T - exture Structure Consistence g Soil Application Ra oundary Roots GPD/tt' In. Mansell t]u. Sz. Cont. Color . - 5 Gr. Sm Sh. 'Eff #1 'Eff #2 1 - f). 2 lik Z -` r mSb s - _ -5 .Z F-1 Boring # ❑ Boring ❑ pit ' Ground surface elev. ft Depth to limiting factor in. Soil Application Rai Horizon Depth Dominant Color Redox Descripion_., ,. Texture Structure Consistence Boundary Roots GPD /W In. Munsell Qu. Sz. ConL Color Gr. Sz. Sh. 'EM I 'Eff#2 a Boring # ❑ Boring El Pit ' Ground surface elev. R Depth to limiting factor In. Soil Application Rat( Horizon Depth Dominant Color Redox Description Texture . Structure Consistence Boundary Roots GPD /ft= In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff #2 Effluent #1 = BODS > 30 < 220 rml/L and TSS >30 < 150 mg/t. ' Effluent #2 = BOD < 30 mg/l, and TSS < 30 mg /1 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. sao-1»0 (RO7=) i PAGE `� OF NAMF �G ► t ac t LOT# Jz LEGAL DESCRIPTION u� �S F 1 4 S Z3 T 30 N R ZG .(ortSW SCALE: I"= yG' BM I ELEVATION /00 BM I DESCRIPTION o f Duc P t BM 2 ELEVATION �9• � BM 2 DESCRIPTION Q SYSTEM ELEVATION 4,p SYSTEM TYPE CONTOUR ELEVATION 9 8 v t I(c • �� 9 S, �0 1 e o 0 a � 0 0 $� Z k io 1 SIGNATURE DATE - —� r -='� •.. - ��1�_ G Q::� ^ �;i 'CA7 4 if C1 VENT P1P > ^ ► E 32 yFN. ABOVE 6iADE t DOOR F'RESN Alit iNTAICF W j? Dow OR WEATHERPROOF JUNCT20N QGX APPRO'wrn T':hZSHEC �o JAI AE WITH CONDUIT `SANI!OLE CovC.,R +v p11 PA D AD L acx I a c� RI sER ; WARNSNG ? Aar WA ER %'i V N T SEALS GAS - i , T . Tr QHT:- A SEAL +; PROWED �ROVE9 11i + .�, ' Jolh7s WITH 'ZPE 3' I R ' A J APPROVED P1Pj y04 J ' 1 P 'M t5 T C MP a• F ELXV . F T . D aFi ' +� RI$E1! EXIT PERMITTED ZV1.Y .,..� ' IF TANX n MANUFACTURER 9 APP140V ED BEDDING UNDER TANK HAS APPROVAL SPECIF IC AT,QNS C4h' =AX, TE PAD j RNK MANt.1FACT"JRFR: er er J►'oMBER DOSES PER DAB: _ � DOSE G A L . IC 1•?. -- GAL, DOSE VCUJ:r:F 1xc:;�JDSIVG 4O FLOWBACK: Jf�..., GAL, 'LAP'! MANUFAMIk : MODEL MJt1s l: CAPA".1 ES: A . I�, -Mrs SWITCH TYPF: _.._metre r.ArRIF 8 = .._? _ ?NCHES �• ��GAL. AC mr4R jM MOM XUPIZ I C � -1--- INCI ES � r0' GAS. SWITCH TypZ; � = QJ +RFA D &C HARGE RA2' r, GPM PUMP t ALAR MIRING AS PZA TLHR 16. £R T:C,AL D i fFt`RI:NC E 8E Z? k'A 1':INZIMUlI HEpRK SUPPLj► OT AND DISTP T BUTZ ON PIPF � - .�_,.,_ FEET FORD F1t•ESSLRS - !? rEE? F.MAIN X T B FT11� • rr 0 F . T . FR. � � —'� FEET ?- N TD'��11. D YHAM2C A KEAD ' : ' �Frr ;TERNA« g DAM NS :t�NS 03� �* E�: PUMP _A.hl+. Lr4�ID c" Tr Y . lIG £d WdT£:TT b00Z 6T -.ldd TZT£98£STL: "ON XUA ONIEwmd dtemuwnHOS: WONA WEXREK SDIL TE STING r -A Goulds PA 7 a R Submetuble �ftlueut Pump 387 EPOS � : goo arlK N drllon for tw � � out o =Wft • Mir Gat Iron '•° ° d Nolr�po waled, Wd 111*w wovk . p Ito rronly. WIM Enema of aw Rou�kI In rb■0 �+ 'Irt�wl�iti�� rote. NIr11M SIN ■hsr f IML vim Mod Mef Md dam rer MW*ff, ham Va to! +r1. Pe''"r'°''a'Q h a +lr..�' J taoll A4do: up fa 24 � p" � M uriwo • Mwg Mug.Qadonrl�Obw r p o M v a � ""■an�i/i�Mw 'oa'b ' ►� wne pr 1 e W3 q u q jur (MA %w mW nuns • ; .rlrl�rr�L �rrdan �roe�. � ° � rre�+.�s. �, � �r nC.� ms s, amble/ brrIrw rbn aortoWOn �� r �rtiet � opM hrleb" Iotei1 %a 1 l s A a s Ids Oou1a• •1r� rwr. . 17d WUT2:TT 1700E GT ' .Idti ZZZ£98£SU -: 'ON Xtjd JNIHWfIid 83muwnHOS: WON Vic*4 STANDARD CHAMBER Quick4 Standard Chamber - -- - — _ (EFFECTIVE LENGTH) I 12' 471 ,� i a i'i I j ■` i t � -- SECTION VIEW SIDE VIEW MuitiPort End Cap -� —' 21 Ol e- C I_ — 3A• _� __� -i SIDE VIEW TOP VIEW FRONT VIEW • � 1 ui andard!: ck4i Cii in parS"eciticstion,t , L ; .. �; . + U11 Po ,t+lotnina atific�iio� 7. 34'x x 1 _ Sills W x x HI' : ` Y '" n "'''y W x ...,_,�...., . 16"x 12 Efiecaive Length _ 48" Invert Heigh 8" or 1.25" IRV � eig nt fa• • l jf�FIl.TR4 8 1rSTj�C. STA�i1UAlittjjJlA�J��►�B�jY :ty. 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Sd WHZ£:ZZ b00Z 6Z ' - TZZ£9BESTL: 'ON XHd UNIswmd m3AuWf1H3S: W08J POWTS OWNERS MANUAL. & MANAGEMENT PLAN Page j of � FAR woof1 "Tll N sriis 3PWfff Owner Sgnlc Tank Cap"Ity ,'� (J ai D NA Permit 0 c 3 Septic Tank manufact wer 0 NA ow" P Effluent Fitter Manufacturer 0 NA Number of 8sdroom y la NA Effl mat Filter Model / Cl NA Number of Pubic Facility Units Pump Tank Capacity sl O NA Estimated flow !average) Qp ci Pump Tani Manufacturer r ❑ NA Design flow (peek), (Erdmated x 1.51 Gt? B g #ft PUMP MsnufsctuW eye rc / 0 NA See Application Rats alid Pump Model O NA Standard in%mnt/Effkmnt Ouslity Monthly average' Pretreatment Unit 0 NA Fats, Oli d Graeae (FOG) 930 moll. 0 Sand /Gravel Fitter 0 Post Filter 8i awnicai Onvgen Demand (8000 $220 gm/L 0 NA C] Mechanical Aeration O Wetland Tote) Suspended Solide ITS0 51 so MOIL G GWnfection 0 Other: Pretroded Effluent Givalky Monthly average Dieverad ee0(s) 0 NA Siooheittical Oxygen Demand (800 s30 mg /L a in-Ground (gravity) l.7 [ (pressurized) Total Suspended Solide (TSSi s30 rny/L 13 NA 0 At -Grade 0 Mound Fecal colife"n 1 eemetric mean) x10 ofu /100rni 0 Drip-Lhw Q !!their: Ma+cirnum Effluent Pwddo Size K In die. 0 NA 0111w. D NA Other O NA N 0 NA o valustr wpktsl IN dwnesde rwalrwow and septic tMak eftiusrR. sy' 0 NA NlA1N TOIAR= SC HWULA #arMea E1rstR Llervioe'tetmattoy Ipepeet oondmw of tat ie) At least once every: 3 E mo rl" a l a VA i ftum 3 ymard 0 HA Pump out 0entenits of unkho When combined sludge end scum squats onwthird 14) of tank Volume 0 NA Inspect dispersal cells) At bast ones very: m (s) (Iilatdrtnlm 3 yeas) O NA Clean effluent nlofnfn sf 17 NA fYtsr At lease .nee every: s Inspect DUMP. purhp control. S alarm At least once every; A s) 0 NA Flush Inewars and proseurq test At least once overt': r 0 mond a) C3 NA At least once W ary: — C i Is) 0 NA Other: C NA MA N MANCE WSTRuGT"Mal 1nap+at1ons of mike and dispersal caNs @hail be made by an Individual canting one of the tollowine licenses or certifications: Master Pkw"ber; Master Plumber Restrict" Sewer. POWTS Inspector; POWTS Maintainer; Septego Servicing Operator, Tank irtepeetions must include a visual inspection of the tanklal to Identify any ndsaing or broken hardware, Identify any cracks or leaks, "w"Urs the volume of combined sludge and srtirn and to check for any back up or pording of effluent On the ground surface. The dispersal "Nis) shall be visually Inspected to check the effluent levels In the observation Pipes and to cheek for any ponding Of efficient oat the Ground surface. Ths pondinp of etftue+tt on the ground outface may ytdicow a falling condhion and requites the 'mm"iaw netifkation of the loud regulatory authority, When the Ownbined wa mulatim of ah+dge and soum In any tank equals ono -third Ilt.) or more of the tank volurne, the entire contents of the ta shell by removed Wisconsin AdminisVtitivs Co", by a 8epta11e Servicing Operator and disposed Of in aeeordwm with chapter NR 113, All other tervioaa, inotvding but not Gmlted to the servicing of effluent flltws, mechaA14111 Or priilaauraed COMPonentx, pretreatment units, end an SVVIOft N Intovals of s 12 months. shall be performed by a certified POWTS Maintainer. A aewioa repot sha ll be provided to the local regulatory authority within 10 drys of mnpletktrn of any swim evens. Zd WH02:TT V00Z 6T .udd TZT1= 982SSZ: 'ON Xtid E)NIEwn1d d3muwnHOS: WOHA Page Z of ?� START UP AND OPERATION, For new construction, prior to use of the POWTS check treatment tanks) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior`to use: System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes: cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or. must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. .! T Ivl alua ' n9 ` b e at . 'i2 1)gIj5 TIC IF /�/ al ' is 2U�t lank ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC. PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name W I L $ L M,/j 6-e_ Name Phone I S. 3 ?(p , 3 12 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name 15t, Ckb ( 24DAIP�J Phone Phone – 71f_ - 3g(p- 0 This document was drafted in compliance with chapter Comm 83.22(21(b)(1)01 &(f) and 83.5401, (2) & (3), Wisconsin Administrstive Code. r POWTS OWNER'S MANUAL & MANAUt:MtN I t'LAN Page ' of 4 FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity a l E3 NA Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer 0 NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity al ❑ NA Estimated flow (average) gal/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) al /d Pump Manufacturer [3 NA Soil Application Rate al /da /ft2 Pump Model ❑ NA Standard Influent/Effluent Quality Monthly average` Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg/L ❑ In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Otter: ❑ NA Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: (3 ea�� 1(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: • year h(s) (Maximum 3 years) ❑ NA • Clean effluent filter At least once every: ❑ year(s) month( ❑ NA pump controls & alarm At least once every: • m year(s) (3 NA Inspect pump, 13 year(s► Flush laterals and pressure test At least once every: [3 m als) 1 ❑ NA ❑ yearr(s) Otther: At least once every: [3 month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal call(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third %) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Adminisuative Code. All other services, Including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at Intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. ST cwix CUuimY 14 N-- SEPTIC TANK MAIN T ENANC'E AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owncr /Buyer St. Joseph Development Corporation Mailing Address 12415 55t Street North, Lake Elmo, MN 55042 Property Address 1 )C� �"I H I I��� L (Verification required from Punning Department for new eorstruction) City/State Town of St . Joseph, WI Parcel Identification Number D ee d t) 30 -2131 03- mm 105 - 4) JYGAL DESCIIPTTON, Property Location NE y,, SW 1 /t, Sec. 23 , T 30 N_R 20 W, Town of S t. Joseph Subdivision Settler's Glen , Lot # �J Certified Survey Map # . Volume . Page # Warranty Deed # 7 0 0 5 6 9 Volume Page # S �� Spec mouse Wyes C) no I.ot lines idcn0able 0(yes CI no SYSTEMiAR�'I'ENANCE . Lnproper use and tminteaance of your septic xystem could result n its Prc=tamfaiture to handle wastes. Proper =ah*aance consists Of puatping out the septic tank every three years or sooner. if needed trf a licensed puzaper. Wheat you put into the Syst<•za can aff d ffie fimcdon of the septic tank as a treatment stage is flee waste disposal systam The property owner agrees to submit to St. Croix Zoning Department a certifrcatiom form. sinned by the owner= and by a mastcrplmnber, joameymaa plumber, rwQictedplurnber or a liomscdpumper verifying that (1) the on -site wastcwatcrdisposal sysum is is proper operating condition and/or (2) a..fer inspection and punting (if necessary), 6c septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the stan dards set forth, herein, as set by the Department of Commerce and the Department of ;`lateral Resources, State of Wisconsin. Certification stating that your septic has bees maintained roust be completed and retumcd to the St Croix County Zoning Office within 30 days of exp' on date. SIGTIATURE OF PLICANT DATE OWNER CERTTPTCATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (art) the O%T1cr(s) of the property above, by virtue of a warranty decd recorded in Register of Deeds Office. SjGf4ArJR.ffOF APPLICANT DATE s « « « ss Any information that is mis- reprrscatedmay result to the sanitary permit being revoked by &.c Zoning Department. " Indude with this application: a stamped warranty deed from the Register of Deeds office a copy of 6c certified survey map if reference is made in the warranty deed k J 2065 P 598 - 7 00569 KATHLEEN H. WALSH Document Number TRUSTEE'S DEED ST. CROI%OCODEEKI HENRY J. LENTZ, as Trustee of The Henry J. Lentz Family Revocable RECEIVED FOR RECORD Trust Agreement dated May 24, 2000; and Bernice A. Lentz, wife of 12/02/2002 01 :00PH Henry J. Lentz, for a valuable consideration conveys without warranty to EXEMPT # ST. JOSEPH DEVELOPMENT CORPORATION, a Minnesota corporation, Grantee, the following described real estate in St. Croix REC FEE: 13.00 County, of Wisconsin: TRANS FEE: 4590.60 ty� COPY FEE: CERT COPY FEE: PAGES: 2 See attached addendum. This is homestead property Recording Area Name and Return Addr ess LAND TITLE, INC 1900 "_'.:: ^CAD NE,7 6Ri ;t�'f ,, ., t.,N 55112 030- 2032 -50 -000; 030 - 2032 -10 -000; 030- 2032 -70 -000, 030 - 2033 -20 -000: 030 - 2033 -40- 000;030- 2043 -10 -000 (Parcel Identification Numbers) Bernice A. Lentz, wife of Henry J. Lentz, joins in this conveyance to relinquish any homestead and marital property interests, but does not join in any of the warranties. Dated this ')L? day of � , 2002. "Henry J. L Trust " *Bernice A. Lentz AUTHENTICATION // ACKNOWLEDGMENT Signature(s)� �t � � � L2 - Q ✓w ^ -i STATE OF WISCONSIN -� � et` ✓ti �Y !'�1. LQ Y i - Y2 ST. CROIX COUNTY 1 Personally came before me this _ day of authen ' ted t is day of ��/ 2002, the above named Henry J. Lentz, as Trustee of the /1 Henry J. Lentz Family Revocable Trust, and Bernice A. d-KX Lentz, to me known to be the person(s) who executed the signature { foregoing instrument and acknowledge the same. type or print name TITLE: MEMBER STATE BAR OF WISCONSIN signature type or print name (If not, authorized by' 706.06, Wis. Stats.) Notary Public St. Croix County, WI THIS INSTRUMENT WAS DRAFTED BY My commission is permanent. (if not, state expiration date: Robert F. Wall .) 'Names of persons signing in any capacity should be typed or printed below their signatures. Lentz TrusteesDeedSlJosephOevetopment -02 1 20651' 599 Property Description - (Henry J. Lentz Family Trust /Grantor to St. Joseph Development Corporation, Grantee) A PARCEL OF LAND LOCATED IN PART OF THE NW 1/4 OF THE SW I/4, PART OF THE NE 1/4 OF THE SW 1/4, PART OF THE SE 1/4 OF THE SW 1/4, PART OF THE NW 1/4 OF THE SE 1/4, AND THE SW 1/4 OF THE SE 1/4 ALL IN SECTION 23, AND IN PART OF THE NE 114 OF THE NW 114 OF SECTION 26, ALL IN T30N, R20W, TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN; DESCRIBED AS FOLLOWS: BEGINNING AT THE SOUTH QUARTER CORNER OF SAID SECTION 23, THENCE S89 0 59'28 "E ALONG THE SOUTH LINE OF THE SETA OF SAID SECTION 23, 1329.95 FEET TO THE EAST LINE OF SAID SW 1/4 OF THE SETA; THENCE N00 °05'53 "W, ALONG LAST SAID EAST LINE AND THE EAST LINE OF THE NW 1/4 OF THE SEI /4, 2662.66 FEET TO THE EAST -WEST QUARTER LINE OF SAID SECTION 23; THENCE S89 °57'49 "W, ALONG SAID EAST -WEST QUARTER LINE, 1103.88 FEET; THENCE S00° 15'03 "E, ALONG THE EAST LINE OF LOT 2 OF CERTIFIED SURVEY MAP RECORDED IN VOLUME 3, PAGE 711, AND THE SOUTHERLY EXTENSION THEREOF 541.62 FEET; THENCE S89 °44'57 "W 349.84 FEET; THENCE N00 °1 5'03 "W A DISTANCE OF 100.00 FEET TO THE SOUTHWEST CORNER OF SAID LOT 2; THENCE ALONG THE SOUTH LINE OF CERTIFIED SURVEY MAP RECORDED IN VOLUME 4 PAGE 944 S89 0 44'57 "W A DISTANCE OF 699.66 FEET TO THE WEST LINE OF LOT "A" OF CERTIFIED SURVEY MAP RECORDED IN VOLUME 4, PAGE 944, AT ABOVE SAID OFFICE; THENCE N00 °15'03 "W, ALONG LAST SAID WEST LINE, 445.55 FEET TO SAID EAST -WEST QUARTER LINE OF SECTION 23; THENCE S89 °57'49 "W, ALONG SAID EAST -WEST QUARTER LINE, 1107.54 FEET; THENCE S00° ] 71 4"E A DISTANCE OF 304.14 FEET; THENCE N89 °41'28 "W A DISTANCE OF 404.95 FEET; THENCE S00 °17'14 "E A DISTANCE OF 1025.47 FEET TO THE NORTH LINE OF THAT PARCEL DESCRIBED ON DEED RECORDED IN VOLUME 562, PAGE 563; THENCE N89 °05'35 "E ALONG LAST SAID NORTH LINE, 1222.12 FEET TO THE EAST LINE OF SAID PARCEL; THENCE S00° 15'40 "E ALONG LAST SAID EAST LINE, 1352.12 FEET; THENCE S02 0 52'23 "E, ALONG LAST SAID EAST LINE 1324.16 FEET TO THE SOUTH LINE OF SAID NEIA OF THE NW 1/4 OF SECTION 26; THENCE N89 °55'00 "E, ALONG LAST SAID SOUTH LINE, 66.08 FEET TO THE WEST LINE OF LOT I OF CERTIFIED SURVEY MAP RECORDED IN VOLUME 5, PAGE 1352, AT ABOVE SAID OFFICE; THENCE NO2 0 52'23 "W, ALONG LAST SAID WEST LINE AND THE WEST LINE OF A PARCEL RECORDED IN VOLUME 623, PAGE 331, 1325.87 FEET; THENCE N00° 15'40 "W, ALONG LAST SAID WEST LINE, AND THE WEST LINE OF LOT 1 OF CERTIFIED SURVEY MAP RECORDED IN VOLUME 2, PAGE 348, 521.61 FEET TO THE :NORTH LINE OF LAST SAID LOT 1; THE ?-ICE S89 °53'49 "E, ALONG LAST SAID NORTH LINE, 894.17 FEET TO THE EAST LINE OF LAST SAID LOT I; THENCE SO4 °28'32 "E, ALONG LAST SAID EAST LINE, 523.40 FEET TO THE SOUTH LINE OF THE SW 114 OF SAID SECTION 23; THENCE S89 0 53'32 "E, ALONG LAST SAID SOUTH LINE, 107.05 FEET TO THE POINT OF BEGINNING. PARCEL CONTAINS 162.778 ACRES, SUBJECT TO RIGHT -OF -WAY FOR S.T.H 35/64 AND C.T.H. "E" AND SUBJECT TO ALL OTHER EASEMENTS, RESTRICTIONS, AND COVENANTS OF RECORD. ................. . ............................... u 3 C =�' 13 LQ4 2 @@H DIM A �!IOdo,Jz UD@.c79 LOT S 3.000 ACRES 130,696 SO. FT. BENCHMARC TOP OF 1' M PIPE ELEVATION =908.2 S89°44 a7"W 349.84 164.87 " OT 3 H:w.L.1 =903.0. 3. ACRES z 130,683 SO. FT. { \ � LOT 4 \ N L.B.O. =905.0 3.000 ACR \ 130,681 SQ. L.B.O. =90: bR AU W \\'° (� EASEMENT f+.. ' \ CV �\ \\ oj \.P H.W.L-903.0 k \\ . �► . mss 20 LOT a" 3.001 ACRES 130,721 SQ. FT. S \ L.B.O. =866.0 Ls OT 7 9 DRAINAGE � �9 L i.,9 _tee