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HomeMy WebLinkAbout030-2131-04-000 + s Wisconsin Department of Commerce Count ~ ,Safety arid Building Division PRIVATE SEWAGE SYSTEM St. Croix INSPECTION REPORT Sanitary Permit No: 506329 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: Manchester Homes St. Joseph, Town of 030 - 2131 -04 -000 CST BM Elev: Insp. BM Elev: BM Description: r'_ Section/Town/Range /Map No: .. I 23.30.20.1058 TANK INFORMATION ,,_' .. ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic F Benchmark Dvs1n Alt. BM p . Aeration Bldg. Sewer 7. Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom _ Dosing Header /Man. Aeration Dist. Pipe p Holding Bot. System 7 -(r f Final Grade PUMP /SIPHON INFORMATION I yi Manufacturer Demand St Cover r ' L GPM , .a 7 i Model Number TDH Lift Friction Loss System Heed TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width , Length No. Of Trenches PIT DIMENSIONS No Of Pits Inside Dia L iquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM -,, - t 1 '- i C 1 4- 4 I` Header /Manifold Distribution I x Hole Size x Hole Spacing Vent to Air take <.i Pipe(s) Y �. �= Length ' Dia + Length Dia Spacing r. g ar_ SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodd ed xx Mulched Bed/Trench Center r r .;' Bed/Trench Edges Topsoil zx . Yes No i«a�, Yes 7N, � x COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / Inspection #2: Location: 1440 Pioneer Circle Houlton, WI 54082 (NW 1/4 SE 1/4 23 T30N R20W) Settler's Glen Lot 41 Parcel No: 23.30.20.1058 1.) Alt BM Description = / 2.) Bldg sewer length = r - amount of cover Plan revision Required? Yes }",No Use other side for additional information. Date Insepctor'$ Signaturq Cert. No SBD -6710 (R.3/97) commerre.wi,gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 Madison, WI 5370 7162 Sanitary Permit Number (to be filled in by Co.) Oeparlmen of Commerce Sanitary Permit Applicatio StateTra^ns /actionNumlxr In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the app iate g tines unit is required prim to obtaining a sanitary permit. Note: Application forms for state PO Project Address (it'differeittt than trailing address) submitted to the Department of Commerce. Personal information y provide rovide may be used seco p urposes in accordance with the Privacy Law, s. 15.04 1 m , Stats. / -7L..J r (, �1 A pplication Information - Please P rint All Informati i Property Owner's arcel p 63 0 I — 6 4 -G�b Property Owner's Mailing Address DEC I roperty Location 7 a e S 7`� `llG�/a7'2 Y t��/` _ ovt. Lot. City, State Zip Code hone n (� y � ' /., Section i t ZON!NG OF F4CF_ I 7 , A 7e /// 1s - N; fL. 0 (circle G o ne 11. Type off Building (check all that apply) Ok t a T �0 or 2 Family I1wellinS Number of Bedrooms O_!d Subdivision Name ptl�. ❑ Public /Commercial - Describe Use �._ ❑ City ❑ State Owned - Describe Use 7 CSM Numbce 0 Village of 1J ` } t � m- W Z' \' G Z �-�►cr ti kSLJown of 4 J /� Ill. Type of Permit: onl &e b o x on line A. Comp line B if applic ., A. New System - - -� y R eplacement System j ❑Treatment /Holding Tank Replacement Only Other Ntruliticatimi to Existing System (explain) List Previous Permit Number and Date Issued It. ❑ Permit Renewal Xy ermit Revision ❑ Change of Plumber ❑ Pnmit Transfer to New t Before Expiration i ' Owner Sa 6 L� 9 J V. Type of POWTS System /Component/Device: (Check all that apply) 'Non- Pressurized In- Ground ❑ Pressurized In- Ground ❑ At- Grade ❑ Mound � 24 in. ofsuitabte soil ❑ Mound < 24 in, of suitable syj.�:, � ,�' y ❑ Holding Tank O Other Dispersal Component (explain) _ _ IJ Pretreatment Device (explain r , /� "t V. Disp ersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpds0 Dispersal Area Required (st) Dispersal Area Propose st) System levatiau VI. Tank Info Capacity in Total >t of Manufacturer J Ga llons Gallons Units New Tanks Existing Tanks d ° a a U LA � in iL V a Septic or Holding Tank a A`0 Dosing Chamber Chamber L_ VI1• Responsibility Statement- 1, the undsrsigncd, assu responsibility for installation of the POWTS sihqwn on the attached plans. Plumber's Name (Print) Plumber's Signature ! 1PRS Number 7 Business Piton Number i1,1J� Its �2 9Q l,� - 3�6 - �- 1'iumbcr's Address (Street, City, State, Zip Code) VIll. Count /De artinent Use Onl Approved Disa Permit Fee Date 1 sued Issum Sera Signature rGi venReason riot _ 1 $ Z�z a �� 1X. Condi tasolts for Disa roust ` t eptict p1 3) Q�:t ' �et�efo �- P ca�.& 1. Septic tank,. effluent finer and dispersal cefl must all he services / maintained o, i-k, OW ^-LA.- as per management plan provided by plumber, t 2. All setback r m be maintained requirements � as pot appikable mod. / ordin.'�r M _ �a o �r f"t rte.. '► a , 1 r'n Alto'h io eornpleie p{aus ro: the systmu and submit to the Cou ty only tin paper not lc ban fl tR x It inches in sisc W es�- : ,.�. µ0t. 'off . SBD -6398 (R. 01/07) Valid thm 01/09 Ajt,J / j Lp('AA, - 1 `� ��}� , Z. V dh s x f / Copy d h� dh h led lee 10 f � RECEIVE® S ! L EVALUATION REPORT Page —L o f5 - Wisconsin Department of G merce (� Division of safety and Buildi Wi s DEC '[ �1�� ;om 85, s. Adm. Code County S( Attach complete site plan n tl less than 81/2 x 11 i siz Ian Parcel I.D. 6` st include, but not limited to: nce n ion 030�Z� t l ('_ pp�j percent slope, scale or di ension�� r oca and distance Data by plesse print ap information. 12 LZ D PomonW information You PT OVlda may bs used rw secondary purposes (Privacy Law. s. 15.04 (1) (m)) Party Owner Property Locat.ion N A rV�. Govt. Lot N L-J 114 x 114 S T C N R 2 Q E (or Property Owner's Mai>ing Address Lot # _ 131ocic # Subd. Name 1 1 e hone r City (] Village WTown Nearest Road (' Oty -'J C �l1IC ® New Construction Use: t3hResidential / Number of bedrooms 3 - Code derived design flow rate s " 00 GPD ❑ Replacement ❑ Public or commercial - Describe: - -.__ - -- - -- A- Parent matedel i �!, ` - r c S Flood Plain elevation if applicable -- CwwW and recommendations: el e v . 1 1 C �1 / i ❑ eonns t ! r # J,� Pit Ground surface elev. % St ft. Depth to Inviting factor f C in. Sca "tion Rate Horizon Depth Dominant Color Redoc Description Texture Structure Consistence Boundary Roots GPD in. Munsell Qu. Sz. Cont. Cola' Gr. Sz. Sh. 'Eff#1 'Efff#2 \vl S Boring it (o ❑ Boring # [ Pit Ground surface elev. JL C ft. Depth to NmbV fades l 3 `t in. $o1l ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIffr in. Mur" Qu. Sz, C ont. Col or Car. Sz. Sh. 'Eff#1 LTM2 Z Z5 `/ 7 s /!o S C C .................................... ..... `b rt ,t ' Effluent 01 • SOD 30 1 220 mglL and TSS 40' 150 m9ft. ' Effluent #2 ° SOD 1 30 mg/L a nd TSS 130 aV& CST Name (Please Print) Sionattxe CST Number G1 V /L - — 2 Cr Address Dale Evaluation Conducted Taleptane Number Sq q �f= va . S�� i SY��' 7(6C- �'z�`� r page 2 at _ ►its ;may parcel to tf property Owner :An ,:, h1. •, n, �. �" � ( _ S ❑Boring �ev.� n. p to firn iting factor _.1�. --• In. sod Rate Swing # Q ( Pit Ground surface GPDIff Consistence g Roots HoriTAn Depth Dominant Da Color Redox sodPtfon Texture Stntchxe .� •Eft#2 ou. Sz. Cont. Color Gr. Sz. Sh. In.. MunaeA 31 — �c ` >c 1 it D solin g — ication Rate Boring # ❑ pit Ground surffscs elev. �� R Depth to limiting factor In. SoU Texture gyre Consistence Boundary Roots GPD1fE Horizon Depth Dominant Color Redox pescriplion . Sz Sh. •Eff#1 -F-02 In. Munsell Qu. Sz. Cont. Color E l O # ❑ � Gmmd surface el".� — ft. Depth to QrrAng Wor -- in. sod tlon Rate 1 � Roots GPDtff Horizon Depth Dominant Col Podox Description. Textuue Structure Consistence Boundary •Eff#1 'Etf#2 In. Munsell tai: Sz. Cont Color Gr. Sz. Sh. EffNtent #1 SOD > 30 _220 rrgJl ■ < and TSS >30 ISO mgtL ' Ef mrd #2 i SOD, <_ 30 mgjL and TSS 530 ITWL- w StanCC to access services or er and em lover. if you need asst e is an equa o pportunity service provider p _ %7. The Department of Commerce q ppo 264-87 need rmateriat in as alternate format, please contact the depattmettt at 60$ -266 -3 l S l or TTY 608 san•utacttboo) f PAcss NAMIL LO�'�1 �' PT N'✓w� /�►SL�/ N RZCiR OR BM I SI.sVATION UL BM t OSOCRIPTI ©ti IBM 2 ELRVATION S MI 2 DRiCRIPTION SYSIrKm ELoVATIO u , �U�/ �Cit !✓� SYsTam TYPI! (� "v► ti1.2 v 11A . ��.-- •- ---� �f G l � commerce.wi.gov Safety and Buildings Division County _ a 241 W. Washington Ave., P.O. Box 7162 - j. s r k s c o n s i n Madison, W1 53707 -7162 Sanitary Permit Number (to be filled in by Co.) G of Comrneroe 1 / ") Sanitary Permit Application State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form tot opriate g rnel _ AJIA unit is required prior to obtaining a sanitary permit. Note; Application fomts for state - POW Projec(Addres ifdifterentthanmailingaddress) submitted to the Department of Commerce. Personal intotntation you provide may be used condary i a j x)ses in ac cordance with the Privacy Law, s. 15.04(l)(m) Stats. i i. Application Information - Please Print All Information Property Owner's Name Parcel / I Property Owner's Mailing Address Property Location \ S � t Phone City, CQk1Pd -- j Govt. Lot y, S ate Li Code I hone D Number I VW /.. /., Section a3 6 sa' � l�: P �� / / /�✓ / ! -- -- (circle one) I 1 - T N; R 11. Type of Building (check all t apply) Lot ay ling - Number o!' droanu Subdivision Name XI or 2 Family Dwel r Q Block p ❑ Public /Commercml - Describe Use E -- ❑ City of I CSM Number C3 Village of _ ❑ State Owned - Describe Use _ Townof Ill. Type of Permit: (Check only one box on line Com plete i B irappl A. XNew System ❑ Replacement System nt /Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) R. ' ❑ Pentat Renewal ❑ Permit Revision d Chan f Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration 0 er IV. Type of POW TS S ystent /Corn onent/Devi(e: Check all ilia r l •f j �1 Non- Pressurized ht- Ground Q Pressurized In- Ground At- Gia Mound > 24 in. ofsuita !e. soil ❑ Mo nd < 24 in. of su ble soil E J Holding Tank Q Other Dispersal Componco explain fy T /ct � err u i cv a explain) V. Dis ersal/1"reatment Ar Informatlq0: r r Design Flow (gptl) Design Soil Applicatiy"Rat e(gpds�t) Dispersal Area Requir (st) Dispeaat Area Proposed (sf) System vation V 1. Tank Info CJlliiacity in Total # of Manufacturer I rallons Gallons Units New Tanks Existing Tanks u e s A. Q en y 6 w 0 a 4 Septic or Holding Tank A , Id X C Q � Dosing Chamber " Vll. Responsibility Sta(eineqf 1, the undersigned, assurne responsibillty for installation of the PO S on the attached plans. _ Plumber's Name (Print) Plum ?per's Signature RS Number [nosiness Phone Number Plumber's Address (Street, P. State, Lip Code) III- ous /De art en _ t Use Onl pproved D Disapproved Permit Fee Date 1 ucd j5suiog Agent Si ture s / 7�Q IGC� C3 Owner Given Reason For Denial -7 CX. Conditions of Approval/Reasons for Disapproval � � � �. � ✓�� SYSTEM OWNER: 1 Septic tank, effluent filter an dispersal cell must all be serviced /maintained � as per management plan provided by plumber. t ft: i21ir11Bt' t an 11 to tree County only on paper not les ilia�nches as per applicable code /ordinances. „s > 'BD -6398 (R. 01/07) Valid thru 01 /0 � CWL_�ax_ it t7o i r j^ I . fk 1\ I -� a �� � fie• QD � �w + 't �rl .f SEPTIC TANK PUMP CHAM$ 2 i»R SS SECTION AND SPECIFICATION _ _ 4" CI VENT PIPE 12" MIN. ABOVE GRAI)Z 6 WEATHERPROOF , 25' FROM DOOR, WINDOW OR FUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER FINISHED GRADE W/ PADLOCK WARNING LABEL 4" CI RISER --•-- -- 4" MIN. 16 "` IN, 6" MAX. ! N LIE T �t WATER TIGHT SEALS GAS- 1 " " TIGHT; " APPROVED A SEAL JOIN WITH �PPRQVED — --- r ALM APPROVED PIPE WE 3' ON 3' ONTO INTO SOLID 1 SOLID SOIL SOIL ..,_ ,t* RISER EXIT :SUMP OFF ELEV . FT, pFF PERMITTED ONLY IF TANK !tANUFACTURER HAS APPROVAL 3" APPROVED BUDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER:.. NUMBER DOSES PER DAY: TANK SIZES SEPTIC Vk GAL. DOS£ Vpi� ME INCLUDING DOSE GAL. FLOWBACK K 9 GAL. AIAR.M MANUFACTURER: Le"plgh Rt. CAPACITIES: A = Q_ INCHES = LI GAL. MODEL NUMBER: D t-y SWITCH TYPE: �0.� !` B = �2 INCHES = L� GAL. PUMP MANUFACTURER: G /'v� C = 9 INCHES = GAL. MODEL NUMBER: SWITCH TYPE: me�C D = INCHES = ak GAL. REQUIRED DISCHARGE RATE L Il) GPM PUMP $ ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE • IQ- FEET + M M NETWORK SUPPLY PRESSURE 2.5 FEET FEET FORCEMAIN X :,(O /100 FT. FRICTION FACTOR . , Sp EET ,TOTAL DYNAMIC HEAD = FEET IN EkNAL DIMENSIONS OF PUMP TANK: LENGTH .�- ; WIDTH ; DIAMETER LIQ UID DEPTH :3 � f &4L Po.R 1 SIGNED: _ � �--- LICENSE NUMBER: s -Qq DATE: _ 1/88 GOULDS PUMPS Submersible Effluent Pump A. EPO4 3871 EP05 APPLICATIONS • Fully submerged in hi ■ EPOS Impeller. Thermoplas• ■ Bearings: Upper and lower Spedfically designed for the grade turbine oil for tic enclosed design for heavy duty bal bearing following uses: lubrication and efficient improved performance. construction. Not transfer. • Casing and Ease: Rugged • Effluent systems thermoplastic design provides AGENCY FISTING • Homes Avaitabie for automatic and superior strength and corrosion • Fars r wAW operation. Auto- carrd o SWW@n F Auadebm • Heavy duty sump matic models include resistance. • Water transfer MedwIcai paM Swish N Motor Housing: Cast Iron (CSA listed model numbers end • Dewatering assembled and preset at the for efficient heat transfer, in "F" or "C ".) fay, strength, and durabllity. SPECIFICATIONS ■ Motor cover: Thermoplastic Q" Furriw 11 ao 900 kgiFw FEATURES cover with integral handle arts! • Solids handling capability-, -- ---- — _ float switch attachment points. Ile maxirnum. ■ EPO4 Irrelier. Thermoplas • Power Cable: Severe dory • Capacities: up to 60 GPM. tic Semi -open design with rated oil and water resistant. • Total heads: up to 31 feet pump out vanes for niechankal • Discharge size: I'b" NPT, seal protectlon, • Mecban'ural seal: carbon - rotary /ceramic - stationary, BONA -N elastomers. • Temperature: 104 RM continuous METERS FEET 140OF (60 intermittent. 0 • Fasteners: 300 series i stainless steel. 9 30' • Capable of running dry without damage to s _ 2.s rr components. ry - ;. __" .. . �."...... _ ... 7 Motor: • EPO4 Single phase: 0.4 HP, a 20:._. 115 or 230 V, 60 Hz, 1550 _ RPM, built in overload with s / automatic reset. it ss . .. • EP05 Single prase: 0.5 HP, 41 EPOS _. . W._ .... 115 Y, 60 Hz, 1550 RPM, * s 1 built in overload with EPO4 automatic reset. 2 • Power cord: 10 foot standard length, 16/3 t SJTOW with three prong grounding plug. Optional 20 o 00 10 20 30 $o . GPM toot length, 16/3 SJTW with three prong grounding plug __.�._ u (standard on EP05), a s e 10 1 2 "01h CAPACITY G oulds Pumps ® 2000 Goulds Pumps <& ITT industries Eftective February, 2000 83871 I " / Wisconsin Department of commerce SOIL EVALUATION REPORT Page I of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 812 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. 03 �?f 3 Please print all information viewed Date Personal information you provide may be used for seo s. (1) (m)). 03 Property Owner Prope Location C am G i�bCY�s Govt. �ot w 1/4 1/4 S T 3p N R ?_ E(oreW Property Owner's Mailing Add U il i of # Block # Subd. Name or CSM# � State Zip Code Ph e N Ci \nIlage E] Town Nearest Road City e^,'u ll i M 550 Z c ) -2gTg7 J� e h [P New Construction Use: Residential I Number of bedrooms - Code derived design flow rate GPD 0 Replacement [ Public or commercial - Describe: c ruS� Flood Plain elevation if applicable �/� # Parent material 41 General comments �5 e Z/, (f. if q/' L o and recommendations: u�o�v ❑ Boring q b &4,t. Boring # • $b ft. Depth to limiting factor �� I � pit Ground surface elev. g / in ' Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 'Eff#2 — COS I – – - 7 Boring # ❑ Boring 2 ®, pit Ground surface elev. . �b ft. Depth to limiting factor / J0 in. Sal 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 c,. i✓5 Z 2 5 id 2016k 04r C_ rn — , _7 N 0" r ' 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) ign ture� T Number Address lf'C Date Evaluation Conducted T lephone Number X6 zq� Property Owner �.rrlao y6y ♦ , Parcel 10 # Page of � Boring # • ❑ Boring L x '` Pit Ground surface, elev. q < <-V ft. Depth to limiting facto In. Horizon Depth Dorninant Color Redox Description Texture Structure Consistence B c Soil Application Ra z In. Munsell t]u. S Coil Color _ ry Roots GPD/W Gr. Sz Sh. 'Eff#1 .. •Eff #2 I O -1 ►6 r 3 c S 2 y- yN s�rLI 2rrr5 cs 3 - i I io - L S . �s m I — — � 1.2 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. R, Depth to rimiting factor in. Soil Application Rai Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fl= In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Effif2 Boring # ❑ Boring ❑ G Pit ' round surface elev. ft. Depth to limiting factor In. Soil Application Rai, Horizon Depth Dominant Color Redox Description Texture . Structure Consistence Boundary Roots GPD /ft= In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'EII #2 Effluent #1 = BOD ;> 30 < 220 ti > < s rng and TSS 30 150 m - _ rJn- 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 M 608 - 264 -8777. SB68370 (R07100) i i i PAGES OF NAb: F. (`a C I OT# # LEGAL DESCRIPTIONS Ya Y ,S Z-S T 3G ,N -R- 00 Ror{W� SCALE: I"= yO BM I ELEVATION /Ud - O BM I DESCRIPTION 6adj j pyc- BM 2 ELEVATION f0 BM 2 DESCRIPTION ) b 1 ". xtL �PC = L SYSTEM ELEVATION ZU �} SYSTEM TYPE C+c,nttcn� -,bow( _ CONTOUR ELEVATION CO 3 45.06 3 oJ kuc V l a \ SIGNATURE l It DATE X 15.5 . 923.3. ® X 91 .'� 10 . ..'... : j. 21.3 _ X B. . 1 3.00 y - 904 -r 9158. X { � . 897.0: WATOC X 903 5 B. X 1.3 0.7 , 905..'x• 1 X 3.7 .,. � 907.1 909. X �� 92 .920.x'' •• `� - X X X 918.9 ,. X • �C x gt 7.6 . \ t r PAGE _OF� NAME Nfrl Z LOT# Y Y4 Z G ZO SCALE: V= Q BM I ELEVATION - a BM I DESCRIPTION e I3M 2 ELEVATIO . IO Pc L BM 2 DESCRIPTION I SYSTEM ELEVATION - ion c SYSTEM TYPE n Itr-k r\A -,o�w( CONTOUR ELEVATION q gtcO 3 g5.�c5 3 g Ov 1 F1 SIGNATURE l `` DATE . ' POWTS OWNER`$ MANUAL & MANAGEMENT PLAN Page /of FiLE INFORMATION YSTEM SPECIFICATIONS Owner > /9 t y /7 �,�5' �j E,,, NA Permit # �m Septic Tank Capacity e tic Tank Manufacturer P NA DESIGN PARAMETERS Itffluant Filter Manufacturer �� ❑ NA Number o f B edroom s _. M NA Effluent Filte Mod el 6 l� �j Q N A - - _ Number of Public Facility Units _ P NA Pump Tank Capacity g Q $ L _ ❑ NA Estimated flow (average) g a pea Pump Tank Manufacturer Vi S� ❑ NA Design flow (peak), ( Estimated x 1.5) " 0 b j / � Pump Manufacturer C ©V , � � ❑ NA Soli Application Rate _ a pump Model al/da ,Lft ❑ NA Standard Influent /Effluent Quality M y r e" Pretreatment Unit _ p NA S3 Fats, Oil & Grease (FOG) 0 mg /L Q SancliGravel Filter O Peat Filter Biochemicai Oxygen Demand (SOD,) _ <220 mg /L NA 11 Meah$nical Aeration ❑ Wetiand Total Suspended Soli (TSS) 5150 mg1L q (,disinfection ❑ Ot her: Pretreated Effluent Quality Biochemical Oxygen Demand IBOD s30 mgll -round (gravity) ❑ In -Gr nd ( pressurized) Total Suspended Solids (TSS) a30 mg /h 4A 0 At- tirade 0 Mound Fe cal Coli #orrtt (geom etric mean) fu!j0Qml 0 D _ O O ther: Maximum Effluent Particle Size Y in di Ca NA Cithar: C- O NA Other: L _ tri NA Sher; NA ✓alues typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE .SCHEDULE Service Event 8ervioe Frequency Inspect condition of tank(s) At least once ever mont s) ---- ---- -- _ y' � i�_year(s) (Maximum S years) D NA Pump out contents of tankis) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal ceii(s) At least once over y ❑monthts) Y ` year(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every. } -� CI monthts) year(s) 0 NA Inspect um C7 monthts! p P pump controls &alarm At !seat once every; r--- -. p NA _ _ ❑ y _ Flush laterals and pressure test At least once every; D months) 0 NA --- © ear(s) At least once every ❑ monthle) ❑ NA 0 yearls) ocher: — C7 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 In* ,p POWTS Maintainer; Septage Servicing Operator.. Tank inspections must include a visual inspection of the tankfsl to identify any musing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any beck up or ponding of effluent on the ground surface. The dispersal cells) shalt be visually inspected to eh(sak the affluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on a round s may ti! g au f y a failing condition and tequilas the immediate notification of the local regulatory authority: When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank steal! be removed by a Septage Servicing (Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent fitters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. 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CR COUNTY SEPTIC TANK MANTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Ownor/Huyer /7? �c � � 7 Q s - %1a1bng Address - _ Z ,,- ,/r s l�Lr1� t_r �L _ 4z ff�6�� Ire- Property Address G O'erifxcation required fk Plamiing & Zoning Aeparnuent for nzw cor stru on.) ('it / Stare C -► (�/ _..._. y City / state Identification Number LEf DESCRI / Property Location,�� '/4 , J ;� %, , Sec. ag _, T ,31� N �� W, "Town, of Subdivision ._ ��. e r. S .�� - -- _— -- - -- i�c�t # -- Certified Survey Map # � , Volume �- , Page # Warranty Deed # $��? �4 , Volume , Page # /d3 Spec house yes Lot lines identifiable: (2a no MAINTENANCE AND OWNER CE R11FICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Propea maitttc consists of pumping out the septic tank. every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a iraatrnanl stage in the waste disposal systein. Owner waintenanee ref are specified in §Comm. 83, 52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. , rbe property owner agrees to submit to St, Croix County Planning & Zoning Department a certification fonn, signed by the owner and by a numer plumber, jou eyrtttYn plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to rataintain the private sewage disposal system with the standards set forth, herein, ag set by the Department of Commered and the Department of Natural Resources, State of Wiroonsin. Cartification Stating that your septic systern has been maftitained must be completed and rea"r"ed to ft St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I /we certify d rat all statements on this form are true to the best of my /our knowledge. I /we am/are the owners) of the pwpetiy described above, by virtue of a warrant) deed .recorded in Register of Deeds Office. Number of TU OF APPLICANT(S) DATE " r *Airy information that is misrepresented may result in the s;mitary permit bcing revoked by the Planning & Zoning Depattnient. rne.lude with tth, application a r warranty deed front the Register of Deeds Of13re and a no y of the Certified. survey ntap if reference is made in the warranty decd. (REV. 0$ /05) tai 2 7 4 1 P 1 3 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI STATE BAR OF WISCONSIN FORM 1 - 2000 RECEIVED FOR RECORD Document Number WARRANTY DEED 02/01/2005 12: 05PI! THIS DEED, made between St. J * WARRANTY DEED a EXEMPT � Minnesota Corporation, Grantor, Manchester Homes, Inc. a Minnesota Corporation, Grantee. REC FEE: 13.00 Grantor, for a valuable consideration, conveys to Grantee the following TRANS FEE: 629.40 described real estate in St. Croix County, State of Wisconsin (the COPY FEE: CC FEE: "Property"): PAGES: 2 SEE ATTACHED EXHIBIT A Recording Area Name and Return Address: Land Title Inc. 1900 Silver Lake Road Suite 200 New Brighton Mn 55112 ;k sS Z Together with all appurtenant rights, title and interests. 03 0-2131 - 04000 030 -25000 Parcel Identification Number (PIN) This jg homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Dated this 28th day of January 2005. St. Jose Development Corporation * Kellei St. Martin, Vice President * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF MINNESOTA ) WASHINGTON COUNTY. ) ss. authenticated this 28th day of January, 2005 Personally came before me this 28th day of January, 2005 the above named Kellei St. Martin, the Vice President of St. * Joseph Development Corporation a Minnesota Corporation, to TITLE: MEMBER STATE BAR OF WISCONSIN me known to be the person(s) who exec5tW the foregoing (If not, instrument an cknowledg e s e. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY *Nancy J. Len Notary Public, State of 4nnesita My commission is pe rmahent. (If not, sta a expiration date: Larry Mountain, Attorney, 1900 Silver Lake Rd #200, New 1 -2--1 � ZOl 0 ) Brighton, MN 55112 (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity must be typed or printed below their signature r # NANCY J. LENTZ Notary Pu IIC- Minnesota z - C ffvni aton Jan 81, 2010 WARRANTY DEED STATE BAR OF WIS 0.1-2000 U. 2741 P 104 EXHIBIT A Lots 4 and 25, Settler's Glen located in the Town of St. Joseph, St. Croix County, Wisconsin. x �s { j ,.,r :.................� .......... ................'°`'° 3 0 W I m M1 o xx _ 0 E�WV 1 � c 1 w as rL JI O O ' 1 3 :i I fi - -_ i ^ way Ig O a ('T1 , r� F W o 1 T}� oow�S v1 � ... .. .... . .... . i 6 Wt w - a aaz,0 ' �j I m �b�t e gg t D o , w I 1 LL Af 4 4 �• I : = ao 1 av� g o , , { 1 - .-ib1.ii 1 / �1 � �° ••... ; / 81 'a 990'MUM 'ONI'£3WOH 83193HONVW 31301108 t8££ (£BL) — • 8984 (£BL) sow0 i LO£99 uyy'ellhlueg0V ti 'ZqL xo9'0'd'ZOL sling'sAVO IBYIsnPul ImWeB 0985 s 130OW U316WVd —I-sg Oul4muo Pus u01sea ewoH wolsn0 �{ o cale�eo d NW30N3CI1S3a jepng •1 sluua0 Aq s3woH ANINnoo FOR a®®® o ®®® o®®® N O N R®®® FEII® ®® FER D®®® � 0®®® M®®® � a® mm N� ® 0 � o Na ®® a Q ®® w w �L � O w' a CO �f Q II FH Y L11 4 � m OLD Z Q �I LU ELI W Z B O ❑ Q W J W Q Q Q II L i OG C Z 0 Q W J ❑ W W J 1 6' I r � V ✓ p O r -- - - r - -- -- -- I I I I I I I I I 4 I I I I = I I I I n I 1 I I — I I I I I I I I � I I I I I I I I I I I I I I I I L --------- - - - - -- i Wj IC I fll I CI I III IC I III F k I II L Fm I L I l L Lu , --------------- - - - - - m2m LO o I I E RR - M L 7 L I I I � I T I I I I - - - - -I I I N 0 � u O 0 0 00 0 m �.o