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030-2131-07-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 514887 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: Glen Johnson Construction, Inc., Glen E. John I St. Joseph, Town of 030 - 2131 -07 -000 CST BM Elev: Insp. BM Elev: I BM Description: Section/Town /Range /Map No: Qt,o /o®• b ed: 23.30.20.1061 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. (1- 6 Septic 11-19 Benchmark, « Dosing l Alt. BM Aeration U o � 9 Bldg. Sewer Holding SUHt Inlets / /oS - SUHt Outlet TANK SETBACK INFORMATION ( Z /0 7S TANK TO P WE BLDG. Vent to Air Intake ROAD Dt Inlet Septic (� _ / Dt Bottom Dosing eader ar��, 41 0 Aeration Dist. Pipe „,, I � D 3 ��• d Holding B ot. Syste 0 -- Final Grade / PUMP /SIPHON INFORMATION k),, �"'` 9. yo /O /• Manufacturer Demand Stir GPM D 1 1 0 7. 1 Model Number D ` TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM = 'L BED /TRENCH Width �jLen g No. Of Trenches PIT DIMENSI S No. Of Pits Inside Dia. Liquid Depth DIMENSIONS Y SETBACK SYSTEM TO P/L BLD WE LAKE /STREAM 6HA MBER CHING anufa INFORMATION O Typ Of System: I �j ) T Model N r 5S PWJ� IBUTION SYSTEM _ Header _ anifold Distribution I /h 5 x Hole Size x Hole Spacing Vent t Air Intake Pipes) Length D7,a Length l (/ Dia A Spacing -- �� SOIL COVER x Pressu Systems Only xx Mound Or At - Grade Systems Only Depth Over J Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Cent Bed/Trench Edges To Ej Yes Yes No No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection # / Inspection #2: Location: 1445 Pioneer Circle Houlton, WI 54082 (SE 1/4 NW 1/4 23 T30N R20W) Settler's Glen Lot 7� Parcel No: 23.30.20.1061 1.) Alt BM Description = ' "� � vv `l /���` �P�Q� ty0 ° �G¢ 2.) Bldg sewer length - U 1 - amount of cover Use other side for additional info Plan revision Required? Yes No S Date j Insepctor's Signature Cert. No. r M �O � Q vz� NL �j C � ECOPY commeree.W1.90V S uildings Division County W' ashi �sconsin � �O , 53E V nary Permit Number (to be filled in by Co.) �Pmbnertt of Conan Madison ® 5 1 '9 Sanitary Permit Applica n JUN 0 3 2008 S Transaction Number In accordance with s. Comm. 83.2! (2), Wis. Adm. Code, submission of this form the appropriate govemrttental m unit is required prior to obtaining a sanitary permit Note: Application fo for she�QB j p submitted to the De jest Address (if different then mailing address Department of Commerce. Personal in you provi may 1�4A1(�otry g ) Purpo in accordance with the Pri Law, S. 15,040 m Stats. / I. Po f A Y � Application Information — Please Print All Information 7 Property Owner's Nance Parcel # t1 ,l� Property Owner's Mailing Address -r-e� Property Location \ `5j �% 1 e .c-' S Xo K / Govt Lot City, State Zip C Phone Number .� � Y, Section 11. Type of Building (check all that apply) k Lot # T„3Ll N; R as E j ZW �lor2 Family Dwelling - Number ofBedr ,� � Subdivision Name ❑ PubliGCommerciai - Describe Use 'J 4'�-i✓ Block # si✓ /'`' ' k "'Se- Q(. City of State Owned - Describe Use / CSM Number ❑ Village of / / / -f- ! Jo Town of 111. Type of Permit: (Cheek only ne box on line A. Complete line B if applicable) A. New System Re lacement Treatment/Holding Tank Y P g Replacement Only Other Modification tD Existing System (explain) System B. Permit Permit Revision Change of Permit Transfer to List Previous Permit Number anal Date Issued Renewal Before Plumber New Owner Expiration IV. Type of POWTS S stem/Com nent/Deviee: Check all a ppbl Non- Pressurized In- Ground EI Pressurized In- Ground Lj At -Grade Lj Mound 2: 24 in. of suitable soil El Mound < 24 in. of suitable soil ❑ Hol mg Tank Lj Other Dispersal Component (explain) t Device (explain) I � V. Dis rsalfrreatment Area Information: „L 4 u - G l LL Design Flow (gpd) Design Soil Application sf1 wired ( Di ] P (�� System Elevation VI. Tank Info Capacity in Total # of Manufacturer Material Gallons Gallons Units New Tanks Existing Tanks 5 , - ?5 ' Septic or Holding Tank �- G�� ,'r mac., t!! p A/ Dosing Chamber G U G yfl cJ <E: ci I C e> C VII. Responsibility Statement- I, the undersigned, assume responsibility for Installation of the POWTS on lire attached plans. Plumber's Name (Print) Plumber's Signature RS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) Y ; e`..✓ VIMM Conn /De rtment Use On Approved _ Permit Fee Date I Issuing t Signature _ Owner en Reason o I S A /5 D . -y / 3 g O I.X. Conditiasons for Disapproval 7 fQ0 (J V j/�� I. Septic tank,.eMuent fitter and 3� J� L °�^- Ueo�1 �r cQc dispersal cell must all be services•/ maintained r I /✓�.t • Fes-. at per management plan provided by plumber. �'l t✓ 2 AN sttlbsck tpukements must be maintained Attach to com plete plans for the systenn and subank to the County only an paper not Iess than 8 14 11 l Incises in sire SBD -6398 (R. 01/07) Valid thru 01 /09 i U� \� vl \ rr� V ' 1 � ry r � _ lop qw 1. ©�D0 ti � I Z _ O w moo\ w ° y ;-i � I ID o CO 4 W z o I ON 6o � � I I W • Z I i� nn.e5, I N p IC - CIRCLE �- �: >I ro a I 11Z trc 3,69,90408 c ;' so9o5s, w 0 r n I r 4zo 4$,' I j I I M. i I N,' i. W o W / W O ' m Z IW fJ C ? 8i C' m 8 �' I I OD y t ss,. j ZI CA (� I c I p : - ,m 0 0 co 0 r J C) n D :13 CO I I ...................... .. ........................ ............................... I I �a'oea J Z ZE6 s! 105 ,09 thaS 3H130 tIAMN 3H130 3Nn .Lsv3 ,0 I t - Wisconsin Department of commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code minty . Attach complete site plan on paper not less than 8 x 11 inches in size. Plan must I include, but not limited to: vertical and horizonlal re ren � Parcel I.D. percent slope, scale or dimensions, north arrow, loca (G nea ' t road. Q �� I " Please print all info ation. Re Dite P t h;ry 1 � t Personal information you pro`�e may be used for ary pu a?(Pavaoy 15.04 1) (m)). d Property Owner _ Prope Location Govt. t IV l 1/4 _5,r 1/4 SL 3 T �0 N R 2Q E (or) Property Owner's Mailing AdOss o Block # I Subd. Name or CSM# City State Zip Code Phone Number ❑ City ❑ V' � Town Nearest Road I ( 1) -2 I llage h I ® New Construction Use: ® Residential / Number of bedrooms _ Code derived design flow rate d GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material U U 4 5 k a Flood Plain elevation if applicable ✓-/ 14 ft. General comments s y — q-e yA e I - j- (D d L U LI o r and recommendations: a Boring # ❑ Boring ® Pit Ground surface elev. ft. Depth to limiting factor J_J_ 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. •Ef1#1 •Eff#2 I b -icy 2 5. I Z c I v 5 8 � i Wo Boring # ❑ Boring ® Pit Ground surface elev. ��� �U ft Depth to limiting facto in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /11 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 -13 Ib . 3 2 Si C I vt .5 P 3 2 -t 10 r `fhP • 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 a e CST Number jj k4 VYtaG ZS3.3iO Address Q � �( �. Date Evaluation Conducted Telephone Number 2113 r I Property Owner ��^_ I �C Y 7S� � Parcel ID . # Page .2- of 3 , Boring W. ❑ 130ring Q ® Pit Ground surface . C) o R. Depth to limiling factor t't_ O in. f"on Soil Application Ra Depth Dominant Color Redox Description Texture Structu a Consistence Boundary Roots GPD/il� In. Munsell Uu. Sz. Cone Color . _.� GF. Sz. Sh. ... 'Eff#1 •Eff #2 d 2 m s i • - I 1 F-1 Boring # ❑Boring ❑ Pit Ground surface elev. R Depth to limiting factor in. Sail Application Rai Horizon Depth Dondnant Color Redox Description.._ Texture _Structure Consistence Boundary Roots GPp /fl' In. Munsell Chi. Sz. Conl. Color Gr. Sz. Sh. •Ett #1 •Eff#2 Boring # ❑ Boring ❑ Pit ' Ground surface elev. ft. Depth to limiting factor In. Soil Application Rai( Horizon [fin, th Dominant Color Redox Description Texture . Structure Consistence Boundary Roots GPD /f z Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 •Eff #2 ' Effluent #1 = BODf > 30 < 220 rng/L and TSS >30 < 150 ma • Effluent #2 = BOD < 30 m 0na and TSS < 30 mg/t. 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. saa1330(P -07 of i Property Owner Parcel ID # Page of B n �— J Boring #� ❑ fl '` ' ® Pit Ground surface_elev. C: � c�0 ft } I � Depth to limiting factor (C� � In. Horizon Depth Dominant Color Redox Description Texture Structuue Consistence Bour►da Soil Application f In. Munsell ou. Sz. Con Color _ rY Roots GPD/ftt Gr. Sz Sh. 'Eff #1 •Effi - -- ")I cJ In vc'f/6 co Boring Boring ❑ fl F El Pit Ground surface elev. ft. Depth to limiting factor in. Sail Application R Horizon Depth . Dominant Color Redox Description .Texture _Structure Consistence Boundary Roots GPD /fit In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Effie a Boring # ❑ Boring ❑ Pit ' Ground surface elev. ft Depth to limiting factor In. Soil Application Ra Horizon Depth Dominant Color Redox Description Texture . Structure Consistence Boundary Roots GP /fit In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff #i 'Eff #2 Effluent #1 = BODs > 30 < 220 rmg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 m _ g/h and TSS < 30 mg /l. The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608 264 - 8777. SeDQIO (RA7M) , PAGE N AME Ca fr Lcz 2A LOT# i FGAL DESCRIPTION d/W %SE X ,S Z � T -2 ,6 N R ZU E UCO SCALE: I"= y0 BM I ELEVATION l(XJ i BM I DESCRIPTION -� 13M 2 ELEVATION /po- 4 /Q DESCRIPTION - BM 2 6 STEM ELEVATION � ,,,, r •(o O SY STEM � q �(o G 9 SYSTEM TYPE NVI91en�Oonol- --�- ~- CONTOUR ELEVATION /00 o ru /OZ .d 1 0 X00 '" v "o , � f SIGNATURE O DATE - Z -� EiU`_�e 5a� i ' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION �SyySTTEm SPECIHCATION8 FOwn i .rieptic Tank Capacity QQQ al ❑ NA # Septic Filter Manufacturer Tank Manufacturer i1 C ❑ NA DESIGN PARAMETERS cturer Po ( `D r ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model ''- ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity gal ❑ NA Estimated flow (average) g al/day Pump Tank Manufacturer sp E3 NA Design flow (peak), (Estimated x 1,5) Pump Manufacturer , o A E3 NA soda _ Pump Model ❑ NA Soil Application Rate al /da /ft� Month) e • Pretreatment Unit ❑ NA Standard Influent /Effluent Quality Y average* Fats, Oil & Grease IFOG) 530 mg /L O Sand /Gravel Filter E3 Peat Fitter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration I] Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) DNA 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 /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Ya in dia. ❑ NA Other ❑ NA Other: ❑ NA Other: ❑ NA Ott: Ci NA 'Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Service Event S�ce Fregt ilifIC ► months) (Mwdmum 3 years) C1 NA Inspect condition of tanks) At least once every: ear(sl Pump out contents of tank(s) When combined sludge and scum equals one -thlM (Y of tank volume ❑ NA � a m) C3 NA Inspect dispersal cells) At least once every: , jn ❑ NA Clean effluent filter At least once every: ❑ NA inspect pump, pump controls & alarm At least once every: w ' ' ❑ months) ❑ NA Flush laterals and pressure test At least once every: ❑ earls) ❑ monthls) ❑ NA Other: At least once every: ❑ eerie! ❑ NA Other: MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following r c c to Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer, Septage r. teaks, inspections must include a visual 'inspection of the tank(s) to identify �Y missing or broken hardware, eon the ground surface• measure the volume of combined sludge and scum and to check for any back up or pondMg of onding The dispersal cells pound be visually In to g of effluent on t he e ground surface b e ate a failing dcondition and requires the of effluent on the g immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equais one-third IY3 more t in accordance with chapter NR 113, contents of the tank shall be removed by a Septage Servicing Operator and Po Wisconsin Administrative Code. pressunzed aompon rts, pretreatmen' All other services, including but not limited to the servicing of effluent filter:, mechanical or units, and any servicing at intervals of 512 months, shall be performed by a certified POVM MM er of service event. A service report shall be provided to the local regulatory authority within 10 days of complet Page of ..__..__. START UP AND OPERATION For new construction, prior to use of the POWTS ahook 0# fqr the presence of painting products or other chemicals that may impede the treatment process and/or dartd oil I If high concentrations are detected have the contents of the tanklsi removed by a septage servicing operotor #t ie. System start up shall not occur when soil conditiorye #6 # il$4, it tive surface. During power outages pump tanks may fill above mien power is restored the excess wastewater will be discharged to the dispersal cell(a) in one large drrdffl t .01 *td may result in the backup or surface discharge of effluent. To avoid this situation have the contents tl f f t ii!'i by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plum bdf �;( i0610 ltd assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispellool "1 14 , 0q 11ot Ot1vM pt "park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at- gradspCi i}ilpl�g1art�Nh, Reduction or elimination of the following from tI j0nprove the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts! I p; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and ve Iliill grease; herbicides; most scraps; medications; oil; f t M painting products; pesticides; sanitary napkins; t ABANDONMENT When the POWTS fails and/or is permanently take.. dtifi d$ #ef1t►�� kli fe. . steps sfiall be taken to insure that the system is properly and safely abandoned In compliance with dt{Ip1fYlfliri±ppnsin Administrative Code: • All piping to tanks and pits shall be disconh4ottji illo� 4ifblidil plpe openings sealed. • The contents of all tanks and pits shall be ri�lyf 091 tilifd lflf11 V t1i11 used of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be +1I4Ef a^td idfftaatEl1 ar 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 fctilotp Ilt�lfliNIP61i b�ert, or must be taken, to provide a code compliant replacement system: 13 A suitable replacement area has been evAI4 rtlq�r 4► �l>r ! for the location of a replacement soil absorption system. The replacement area should be #4,09d compaction and should not be infringed upon by required setbacks from existing and prop o6+1 ?1ktf ixt, 00 walla. Failure to protect the replacement area will result in the need for a new soil and site ev , p ;,Ili rl tl s 44able replacement area. Replacement systems must comply with the rules In effect at that time A suitable replacement area is not avail i r soil limitations. Barring advances in POWTS ❑ it J ( tp �lt technology a holding tank may be installed 1`p14d'►e fail ad POWTS. �1 NJ The site as not en evaluated to id anti li iltt� A�Ij area. Upon failure of the POWTS a soil and site 1 evaluation be performed to locate a stilt �a. if no replacement area is available a holding tank may b a{ {e s a last resort to replace f:tiMI�S C] Mound and at-grade soli absorption systeftJO )f1i�( 004A q �flf i.0 in place following removal of the biomat at the Infiltrative surface Reconstructions of such iiyi{ti{1�i1I i the rules in effect at that time < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT tANKS if SE,S AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT f STANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE ADDITIONAL COMMENTS r POWTS INSTALLER l TAINER Name 11A C Phone ? I �' 3 S --.31 a l SEPTAGE SERVICING OPERATOR (PUMPER) LATORY AUTHORITY Name liN1 (fco 2 ^ } Phone t k Administrative Code This document was drafted in compliance with chapter Comm $040 ito I )(9) I+ lfi rilicl 1lp,,$4(ti, t2) $ (3), Wisconsin . • SEPTIC TANK � :'UMW' �HAZ".S�R c:xv� � JL' . a A .... • - - WEATHERPROOF APPROVED 4�' Cl' VENT PIPE' 12 190VE GRADE ,JUNCTION BOX MAN HOLE COVER y 25' FROM DOOR, WINDOW OR WITH CONDUIT W/ PADLOCK E FRESH AIR INTAKE WAR14ING LABEL FINISHED GRADE 4 .� Cl RISER 4 MIN• a +F Imp pt MAX NLET GAS* WATER TIGHT SEALS —�"' 'TIGHT PRQVED A SEAL ;fIKTS WITH LM APPROVED PIPE ...i..- 3' ONTO PPROVED ON SOLID SOIL IPE S' C + ** RISER EXIT 0 0 SOLID OFF PUMP OFF ELEV . FT $ '"' "~ PERMITTED ONL) D MANUFACTURER HAS APPROVAL 3" APPROVED. BEDDING UNDER TANK CONCRETE PAD SPECIFTCATIONs SEPTIC / DOSE NUMBER DOSES PER DAY: TANK MANUFACTURER! / .`GSAr SEPTIC , f, , ,^ L • DOSE V 43�3ME FLOWBACK: GAL TANK SIZES DOSE "L' INCHES GAL CAPACITIES: A ALARM M EL NUMBER: s• y g s 2 INCHES = GAL SWITCH TYPE: .�,..�..� I:, C _g INCHES = GAL � PUMP MANUFACTURER: lo+r INCHES = ��@AL MODEL NUMBER: D '"r' 16.2 WA SWITCH TYPE: DISCHARGE A�ATE _ GPM PUMP & ALARM WIRING AS PER ILKR REQUIRED DI ,o FEET DIFFERENCE aETWEEN PUMP qFF AND DISTRIBUTION PIPE • —•�• FEET VERTICAL MSNIMUM NETWORK SUPPLY PRESSU TOR T114t� . •FRICTION FA FEET • /" ? FEET + FEET FORC}IAIN X . TOTAL DYNAMIC HEAD =. D IAMETER INTERNAL DIMENSIONS OF PUMP TANKS LIQUID �• s` —• 1�.d7.� �O�'da DATE: ..4 LICENSE NUKRZR • . --- SIGNED. q Ann PUMPS [QGOULDS Submersible Effluent Pump 3871 EPO4 EP05 3, APPLICATIONS • Fully submerged in high ■ EPOS Impeller. Thermoplas- ■ Bearings: Upper and lower Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing S P Y 9 lubrication and efficient improved performance. construction. following uses: heat transfer. ■ Casing and Base: Rugged • Effluent systems thermoplastic design provides AGENCY LISTING • Homes Available for automatic and superior strength and corrosion • Farms manual operation. Auto- resistance. 6' Ca ardsAss0dW0 • Heavy duty sump matic models include ■Motor Housing: Cast iron (CSA listed model numbers end • Water transfer Mechanical Float Switch for efficient heat transfer, in "F" or "C °.) strength, • Dewatering assembled and preset at the , factory. and durability, SPECIFICATIONS ■ Motor Cover. Thermoplastic Goulds PumPs is 50 9W1 FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. 1 /0 maximum. ■ EPO4 Impeller. Thermoplas- ■ Power Cable: Severe duty • 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 mechanical • Discharge size: 1 1 /2° NPT. seal protection. • Mechanical seal: carbon- rotary/ceramic- stationary, BUNA -N elastomers. • Temperature: 104OF (4O continuous . METERS FEET ... _. -- 3 - - 140°F(60°C)intermittent. 19 ;. _... • Fasteners: 300 series stainless steel. 9 30 - SGPM • Capable of running dry without damage to a 25rr ! components. zs ..... -- _..._._. ? .- ...... ;.. ; .... _. ...._ - { k-- , Motor. • EPO4 Single phase: 0.4 HP, _ 115 or 230 V, 60 Hz, 1550 a s ' RPM, built in overload with - - - -+ -- - — , - - r .. _ automatic reset. a q 15i _._.; -EPOS ' • EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, ~ s o, _ _.. __. __ . __ ....__. ,- _ ... - -- - built in overload with i_._._ Ep04 ..._.... automatic reset. 2 5 _...._ . . • Power cord: 10 foot _.... standard length, 16/3 ..... STOW with three prong grounding plug. Optional 20 0 % ..__ t0 zo . so 40 50 GPM foot length, 16/3 S1TW with three prong grounding plug o z 4 6 a 10 12 ml /h (standard on EP05). CAPACITY Goulds Pumps ITT Industries ®2000 Goulds Pumps Effective February, 2000 B3871 - -- - - -- --- .. -.-. ST. CR CO UNTY SEPTIC TANK MAYNTENANCE AOREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Bu ,rig �i, * G - Y) moo Mailing Address SS �- _ (0 Property Ad:dross � Lne n L �J 'C) -- (Verification required from Planning & Zoning Department for new comtruction.) City /State ,�DL� Parcel Identification Ntunber LEGAL DESCRIPTION � Property Locaiions '/. , r /. ' , Sec. T N R W, Town of Y 1 Subdivision —C S VQ 1 _ . Lot # Certitted Survey Map # _ T , Volume _ . Page Warranty Deed # 7t' J , Volume �?17 �� . Page # l0 Spec house yes / Lot lines identifiable yes no SYSTEM MAINUNANCE AND 9 CERTIErATION Improper use and ttadutenance of your septic ayatem could result in Its pic tune faihrro to handlo wastes. Proper tnaintenartce consists of pumping out the septic tank every throe years or sooner, if needed, by a Hcensod 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 Imitmnance responsibilities are specified in §Conan. 83.52(1) and in Chapter 11 • St. Croix County Sanitary Ordinance. The prvpertr owrwr agr9m to submit to St. Croix County Planning & ?.onmg Dep=uwnt a cerdfication form, signM by the owner and by a master plumber, journeyman plumb-or, iwarictod plumber or a liconsed putuper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspoctiou and pumping (if neeossary), the septic took- is ICU than 113 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, heroin, as set by the Deparuaartt of Commerce and the Department of Naurd Rosomces, State of WisconsbL Certification stating that your septic system has been maintained must be completed and returned to the St Croix County Plazming dt Zoning Department within 30 days of the three year expiration date. i /we certify that all statements an this form are true to the bwct of my /our knowledge. Uwe mWare the owner(it) of the property dewuibod above, by virtue of a warranty deed recorded in Register of Deeds Of Number bedrooms SIGN OF APPLICANTS) DATE •` «Any information that is minWresentod may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Lee& Office and a copy of the certified sun -ey map if reference is made in the warranty deed U 2710P 636 STATE BAR OF WISCONSIN FORM I - 2000 -7a 1 WARRANTY DEED KATHLEEN H. WALSH Document Number REGISTER OF DEEDS tern ST. CROIX CO.. WI THIS DEED, made between St. Joseph Development Corp° a Minnesota RECEIVED FOR RECORD Corporation Grantor, and Glen Johnson Construction, Inc., Grantee. Grantor, for a valuable consideration, conveys to Grantee the following 1 2/08/2004 10:00AN described real estate in St. Croix County, State of Wisconsin (the WARR DEED "Property "): # COPY w %.. �0 SEE ATTACHED EXHIBIT A P A GE S: CCFEE: 2 Recording Area Name and Return Address: Land Title Inc. 1900 Silver Lake Road Suite 200 New Brighton Mn 55112 Together with all appurtenant rights, title and interests. 030- 2 -20 -100 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 Dated this 30th day of November 2004. St. Jose Development CqTporation ellei St. Martin, Vice President AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF Minnesota ) WASHINGTON COUNTY. ) ss. authenticated this 30th day of November, 2004 Personally came before me this 30th day of November 2004 the above named Kellei St. Martin Vice President of St. * Joseph Development Cornnesota C orporation t o m e TITLE: MEMBER STATE BAR OF WISCONSIN known to be the person(s) whq executed the foregoing instrum t and ackno t dged t e s ([f not, authorized by § 706.06, Wis. Slats.) THIS INSTRUMENT WAS DRAFTED BY *Nan L entz Notary Pu tic, State f M' nesota My commission is permanent. (If not, state expiration date: Larry Mountain Attorney 1900 Silver Lake Road Suite 200 New Brighton Mn 55112 (Signatures may he authenticated or acknowledged. Both are not necessary.) NANCY J. LENTZ *Names of persons signing in any capacity must be typed or printed below their signature NOTARY PUBLIC-MINNESOTA 10 AA ,j Comrr. E Jai 31, 2005 WARRANTY DEED STATE BAR OF WISCONSIN FORM No. I -2000 V, 2710P 637 EXHIBIT A Lots 7 and 42, Settler's Glen located in the Town of St. Joseph, St. Croix County, Wisconsin. COUNTY PLAT OF: SETTLER'S GLEN LOCATED IN PART OF THE NW V4 OF THE SWIM, PART OF THE NB V4 OF THE SW U4, PART OF THE SEV4 OF THE SWV4, PART OF THE KWV4 OF THE SEV4, THE SW114 OF THE SKIM OF SECTION X% AND IN PART OF THE NBV4 OF THE NW 1/4 OF SECTION 24S. ALL IN T30N, R20W, TOWN OF ST. JOSEPH, Sr. CROIX COUNTY, WISCONSIN. ------- --------- ------ -- -- -- - - - ---- THE %BCV"70H& TFAL EA9[MEM 1100.7E AM THE CCNSERVAMON EASBA9lrr - --- -- SHOM ON THIS PLAT ARECOWeYED TO THE Taim OF Sr. JOSEPH. ................. ............ ...... .. ............... ....................................................... 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