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030-2131-15-000
artment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix ..ding Division INSPECTION REPORT Sanitary Permit No: 453133 t�I _RAL INFORMATION (ATTACH TC- PERMIT) State Plan ID No: mal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. , rmit Holder's Name: City Village X Township Parcel Tax No: St Joese h Development Corp St. Joseph Township 030 - 2131 -15 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: /�Z 1 6 (V\ Gt�; ` r 23.30.20.1069 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic T Benchm rk z 6 c_ut z0�- �. /,45.4 Alt. BM F I ttl 21 3 'C> I /az Aeration Bldg. Sewer -7 - 6 5 qy .55 Holding SUHt Inlet TANK SETBACK INFORMATION St /Ht Outlet 97.Z TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic �! j Dt Bottom N Dosing Header /Man. Aeration Dist. Pipe /b. Z5 T5.3 5 Holding Bot. System Final Grade G PUMP /SIPHON INFORMATION Manufacturer Demand St Cover G Model Number TDH Li Friction Loss System Head TDH Ft Forcemain la. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width J Length j No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 WZ Z , -_ * ""� _` SETBACK SYSTEM TO P/L BLDG WELL G � LAKE /STREAM LEACHING ; Manufacturer:- 7Q;( �1 _ INFORMATION /� CHAMBER OR dl Number: — It1� `"tY1. Type f System: t 3 1� UNIT Moe J; <, t< f%o") DISTRIBUTION SYSTEM /�( d - ' Z, q ::5r Header /Manifold Distriblutiti`on `\ x Hole Size x Hole Spacing Vent to AiAntak� —L_ P Dia Spacing 1pe(s ZY�� d—(d Length Dia Length 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 L, • �C Bed/Trench Edges ` Topsoil \ ''` J Yes No Yes No S. Off+ J �. r'tn0 COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 163 Heritage Tr Un known (NW 1/4 SE 1/4 23 T30N R20W) Settler's Glen Lot 15 L Parcel No: 23.30.20.1069 1.) Alt BM Description 2.) Bldg sewer length = Pr v - amount of cover = 3 information. v —�� P l Re s de for additional Yes o -- '` / � 1 / 53� 75 Use other (�1!.�� SBD -6710 (R.3/97) Date Insepc is Signa e Cert. No. Sllfr�ty and Buildings Division County N' tiscons n 201 W. Was S�G,ra k tt�di Sanitary Permit Number (to be filled in by Co.) Department of Commerce 26&3151 Sanitary Permi i ' State Plan 1.D. Number In accord with Comm 93.21, Wis. Adm. Code, pets V F may be used for secondary purposes Pri vacy Law, 15. �y ����UN f Y r I _ i _ ING OFFICE 4 Address (if different than mailing address) t Application Information Pie Print Alt Ilformation X463 /fi Va (a Proper�Owrar's Na me _ cel p Lot / Block � gj r� Ds Property Owner's M ailing Address Property Location � - City, State Zip Code �� '', 'A, Sectio „7f ! i P - �� I —P 1 -- �.�_ 3D' N: H ( �lercte Q'5) II. Type of Building (check ail that apply) P6 or 2 Fandly Dwelling - Number of Bedrooms ' �`� � . Name I- PubliciCommercial - Describe Use State Owned - Describe Use Z - 4? _ t ZZ �, ! C� S� �JVifla e owlish of 11I. Type of Permit: (Check onl one box on lin A. C omplete li>l B if appllcxble} I - �? dse - A. New System Replacement System ❑ Treatmentitlo:ding Tank Replacement Only i Lam` Other Modification to Existing System r B• ❑ Permit Renewal Permit Revision ❑ Change of Q Permit'fransfer to New List Previous Permit Number avid Date Issued B�relE, iratio n Plu mber Owner _ ys3 t'Y i rv• T ype of 1?2WT•S System: (Ch all that ae"i — rNon - Pressurized !n - Ground ❑Mound > 24 in. of sunabie soil ❑ Mound c 24 in. of sortable soil ❑ At -Grads L Single Pass Sato! Filter ' { 1� Constructed Wetland ❑ Pressurized In- Ground ❑ Hording Tan), G Peat Fitter ❑ Aerobic Treatment Unit LI Recirculating Sand Filter r ❑ Recirculating Synthetic Media Filter Yaeaching Chamber Drip Line ❑ Gravel - Pipe ❑ (e xplain) V. Iks rsal /Treatment Area Information Oder ��� Design Flow (gpd) Design Soil Application Rate(gpdsf} Dispersal Area Required (sf) Dispersal Area Proposed (so System Elevation f VI - Tank Info Capacity in Total Number Ma�iufacturer -- Gallons oncrete Const i Prefab Sit- Steel l Fiber j Plastic Gallons I of Units 1 Cruted Glass I i New Existing Tan6 Taub peptic or Holding Tank -- --- Aerobic Treatment Unit —�— I I [7,ising Chamber ! - •- -�-- � VIl, Res ins bilit S _.�[w y tatement I, the u stdersi g ntd, a r t s � po o stbi)jty fr_ sntlon at rite PQWTS shown oil the attached plain _ j Plumber's Na me (Print) Plumber's Si naturo — — ! g RS Numl;er Business Phone Numtrer - -- - f Y ? 0" Plumber's Addre ss (Street, City, State, Zip Code)� / - - -- -- - vlld, Count /De artnterlt Cfse Onl ' -- j pproved ❑ appro�,, Sanitary Permit F (includes Groundwater Date Iss Issuing t Signal ( Slain i Surcharge Fee) i l _ ❑ tier t Reason for I.X. conditions of A-- — -- pproval/Reastnls for Disapproval - i SYSTEM tlhflmm: 1 1. Septic tiMt, effluent fllW and �� �✓ 6�5 r"t`a� r \ D �— ` dispersal cell must all be services / mainta as per management plan provided by plumber. 2. Ali setback requirements must be maintained as per applicable rode 1 ordinances. L Attach eompkie pltw (to the Comity only) for the system on paper not kq t6ast 114 x 1I inches in size '� J CY1t\ LrfAn �t� n� en.r� \ i \ 'V i N 4 f� I sdc�a`a X ys COPY ter_ yqoo A ° A Wisconsin Dapniment ofCommomu SOIL EVALUATION REPORT Pa —L ot Division of Saf0tv a'td euiidings In accordance vufth Lamm 63. Ws. Adm. Code Count' Attach complete site plan on paper not led* than 0112 x 17 inches in size, Pier. must - i Inch, but not 14nited to; vela col and horizortat rsfaranco point (CAM), Ora xfon and Parod I.D. percent slope, soele or dimensions, north arrow, and locarion and aistanco to neorost road. Please print a# Information. Revlewed by Date Pero"I trift"otivn you q vide msy be used for sew twy pvTo. b (PAVdty LAW, e_ 18.04 (1) (m)). S �� PmWty Owner G��,✓ Obi,✓ p.t/ cavcr' PropertyLocatlan Govt. Lot SGrJ 114 Cl4 3, T N R ,� E (01) t`roperty Owner's Mailing Address Lot # Block # Subd Name or CS&W d L e e oD'r i S'C-4y Ma te zi C ode Phone Number 0 City [} villAga 0 Town Nearest Road ® Now ronsPuction Use: ($ Rosidonlial) Number of bedrooms _y Cale, derived design flow rate � `� s �f d � GPD ❑ Replamment (Q Public or Commercial • Describe: - - - -- Parent mate" �[} � - Cl y_, T c?°� Hod o Plain elevation If applicable __ if�� f� _ ft. and racnmm9 do n a ti tions` r ` ` ( � F ( I # (� pit Ground surface elev. ld �' U h. Depth to Enri ing factor � _ in. Soil Application Rats Horizon Depth Dominant Color Redm Description Texture Structure Ctmaistence Boundary Roots G PLff in. Munsell Ou. $t. Cont. Color Gr. Sz. Sh. _ 'Etf#1 'Eff#2 0 j % r ) in 4. e 3 T F 1 te L... _. Pit Ground surface n, fev. /a �_ R. Depth to Limiting factor h. 5A Pie Horizon Depth Deminent Color — Redox Desription Texture Structure Consistence Boundary Roots GPDHf in. MunseN Qu Sz_ Cant_ Caw Gr. Sz. Sh. 'ElW1 *EM /OVI 4 11 1 1 >f I Bflluent #1 a 13OD, N 34 < 22D nvk and TSS >30 1+54 ' Ef vent 02 = ®OD : 30 mQR and TSS !S 30 rn gll. CST Name (Please Print) ignatu CST Number C .S Arddrnsy Data Evaluation Conducted Tetepi'w Number Td WdST :60 SOOE Ba ' 'Ohl ? <b'd WO -jd d p ace a Property owner _ -[ J�.^ Peroet to # P ._..__- 9 Boring # ��} pit Ground surface plw, l d ft, Depth to timittng factor .j- 3d _ in, Sou Apoft" Rate Horizon Depth Dominant Color Redox Desczipdon Texture Sbwwre Consistence Boundary Roots GPDRt' in, Munsell Qu. Sz. Coat Color Gr, Sz. Sh, / Eff#1 *Eft#2 o -d,7G e L 4/ ' S Q ✓- C tom _ AP 1 L� Boring # 0 n9 ❑ Pit Ground surface elev. - - 11. Depth to limiting factor in. icavon Rate Hortmn Depth Dominant Color Redox description Texture Stnx ture Consistence Boundary Roots GPDOW in. Munsefl tau. E,z., Cont. Color Gc Sz. Sh. 4 041 'EfM2 I i Bodng # ❑ $Orin) ❑ Pit Ground sts1aca elev, It, Depth to Nmlting factor in. $0 82pB=t1cn Rate Horizon Depth Dominant Color Redox Desuiptlan. Texture Stmcture Consistence Boundary Roots op ti in. Munsell QU, SL COM. Color Gr, Sr. Sh, 'Eff#9 '022 Effluent 01 = 000 n 30 220 mg1L 2nd TSS >w : 150 "VtL • Effluent #2 = B00 30 n gA and TSS S 3D rnWL The Department of Commerce is an equal opportunity service provider and employer. if you necd assistance to access services or need material in an altet:tate format, pleasc contact tho department at 60tt-266 -3I51 or TTY 609 -264 -9777. soo•eatoot.exal Ed WdST :60 GOOFE 80 '6111- 'ON hdd WOHJ l f PA 131R �r� NAME._ t/ LO'T# lS LEGAL DESCRIPTION 1 /4 ' /e,S T s N,R E(OR)W SCALE: I d f BM 1 ELEVATION_ C,) CJ BM T DESCRIPTION �� 7DD a u � ✓� Qu � BM 2 ELEVATION BM 2 DESCRIPTION SYSTEM ELEVATION �� C1 U SYSTEM TYF+E flUPvlte'U����� - rr S r 1 � ' I 1 °� o ff• f � 1 Ed WdST :b0 S80c 80 5 ny : OFI XH—d w0d3 i ( � MA Safety and Bu dil ng� s Division County 201 W. Washington Ave., P.O. Box 7162 ST GHQ ,/ V Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266-3151 San" tar Permit • • sta Plaa N mit lica t1� I r In PP n accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, sl5.04(1)(m) — Project Address (ifdif / feren[ than mailing ad j I( APPheati Ltformation - Please Pont All Int'orm Mae r� / 3 ae� Property Owner's Na Parcel # Lot # Block # 1 Property Owner's M ailing A ss Pro anon & OHI 1 ?131 ,6 ity, States Zip Code Phone Number ''A ly,Section 0 6 ~ i 9 � 6 �� (circle 1 I It. Type of Building (check all that apply) T,.� N. RE I or 2 Family Dwelling - Number of Bedrooms ' A Subdivision Name CSM Number � Public/ Commercial - Describe Use _ sC � Ale I ❑ State Owned - Describe Use D f �; GtJ QCity ❑Village,&ownship of j { III. Type of Permit: (Check only one box on line A. Co lets li B if applicable) ! A. New System -- Y ❑ Replacement System ❑ Treatme olding Tank Replacement Only ❑ Other Modification to Existing System B• ❑ Permit Renewal ❑ Permit Revision ❑ Chat a of ❑ Permit Transfer to New List Previous Permit Number and Date 1ssued , Before Expiration Plum r Owner N. lype of POWTS System: (Check all that a 1 Non - Pressurised 1n- Ground U Mound > 24 in. suitable soil ❑ Mound 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter (❑ Constructed Weiland ❑ Pressurized In -Grou ❑ Holding Tank ❑ Peat Fil ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter j ❑ Recirculating Synthetic Media Filter VLea in . to rip Lin • ❑ a_ 1 -less Pipe, L'.4 ther (ex lai V. Dis rsai /Treatntent Area Informatio S Design Flow (gpd) Design Soil A it 8 pp ca[io ate( Dis Ar ea gP�t? pe ea Reyutred (fj rsal Area Proposed {s stem Elevation J 7G�cic� VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons , of Units Cotterete Constructed Glass New Ex' ng Tanks T Septic; or Holding Tank `-' - -- aerobic Treatment Unit - t.� �i130 Dosing Chamber d < s/ VII. Responsibility Sta ent- I, the undersigned, assume responsibility for inog1lation of the POWTS shown on t t tached pla its. Plumber's Na me (Print) Plumber's Si gnature P PRS Number Bus s Phone Number i 4 - Plumber's Addre s s (S ee City, tate Zip p Code) J / M u G --i` VI nt JDe tment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date '-sue d mg Age t Signature mps) Surcharge Fee) / ❑ Owner Given Reason for Denial IX. Conditions of A roval/Reasons for Dis a p proval PP pp al "�u -'a" �( _&� iayv k%'+jAL f Vd l d�, - el 2 I Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches is size SBD -6398 (R. 01/03) Hoa s � -c NN IMC*4row STANDARD CHAMBER l FQUi1ck4 Standard Chamber -- 48„ �_ I (EFFECTIVE LENGTH) fj 4 1 i -- — 34" SIDE VIEW - SECTION VIEW MultiPort End Cap rte 1 � ° fir 1 - - ��— — - -�— 34 - - - -- — �.� SIDE VIEW TOP VIEW FRONT VIEW �* ° Quick4 Standard Chambe �No�inal Specifications rx =r �Ilult�Port ;end Ga LPIamE�a1 > S ecficaiions � �`�� ��.: w, 2r�' Effective Length 48" i nvert Height 8" or 1.25" Invert Hei g" - NFILT TOR SYSTE(y,S INC STANDARD UMITp WARRANT (al The sird0l'ur„t 'r4eg t of ee'h champBr, end Dlala, wfkiga and other a(x,c:,SUry rnnuWcturud hY t INI¢atx ('Uni wlrerr it stalloo aed oflaraled !n J leachli. W an or ii- ,ap ic: system In aCCadetica wtn Intatrator's it s1 r bn,,. is warier +rid 10 thn orrg"ial aar-;i I - Hader ', agaelst nefec.l rnatertars anq work a ,hip kr ;rri year Inxn the [Idle that Iha saptiC parr rss,.od f ;x (ne sapitC system Csr1l'abimg the Uni Drow'ded, however, h'ial tf a septlC perme ti nr,1 required tR' applirabb law, the vmJnrly ;gnud writ basin upon fhe dale U at istallalipI of the septic system cobra enras. To exeruse Its waranty Ag1/ts. Holder must ncfify InfiNrator n wiling at its GCrpcyale Flan 9qu ul ±rs In Old 5aybrcrtid, (;urinei vomit litim, (15) �la)'S Oi the etiegad dnidx:l. IriNl(rdldlr will SuDON raplacemert U tIS for Unil J., r ninari t y I tilt lur to Ile cgva :eq I>y llns Lmaed Warranty ' Me Intllrai,x s liatrkty sfJBCifirnity axcindes Ihn cost c'remcwe� a dyo in:aallalx I ihq Units ill T4If LIMIT,,[: WARRAN'Y ANC AEMpIJ1i c tN SINJPARACRAPii tat ARC Ct(.LUSIVt l7 a f <H C 1 L- NC` Ci1NEn WARRANTIES WITtI RESP[CT 0 T[_r n F UNff„ INI,L.UDI G NO IMPi IED WARRANTIES OF MEW( IiANTAl1LITY OR 1 -111'& , i -Qfi A PAR, ICULAR PURPOSE. S�'ST h /� IN ; it l inrllud Wallwly shall ne id if any p at �l Iho enarrh., System rJfar 1Lrfed or anyone other Iii rrldt+ator. The Limliro' W !rrarllV does `•�7 F � � r' v not extf nil In Nr lrlpn l cona r d s ;>PC ai Or a damaylls. Willi Shall 1.(,j ba Iwbin Ira petlalix's a G4udaled damages :lulling toss of Envim mmt8l OnSite Weslowiter .So /udone Drafuctin anU proN[s, lahclr anq _.alenals. overhead casts, or ollrar Icsses a expenses Inr_urnxl Lg the Natter Or any thirci parry. opacillcaiiy exckxk:d tarn jn t (f Warranty coverage are daznaye to the Units due to ordinary wear and terr, alteration, dcc'ident, misuse, abuse a rlegieCl of E.7 r� [� p,, p the Unite: lhD Units Swing subjadaed to vehicle traffic Ur other dxnrptions rKlich are no( permdldx; by Ire olstalatim i115urrcticns; failure `:o maintain the 6 �U$Ii1G$$ [ Road ' r.0. LJl/x 768 mi [fl, ground ouver itb set fWh in the installation Ins1=1110FIS: the Dta('elilen: of in:arop& materiale into the w, tern containing 11rri L,hili failure of me Lln:ts a the sepiiC System due to improper siting or Improper uzulg, e,<rotisiM water usage, anprvpe( grease disposa6 or improper operatiior, a Old Saybrook, CT 06475 any other event not Caused try ig0trator. 'his'- tmited Warranty snail hS void it the Holder lads to cornp)y with al! of the terms set forth In tMS Limited Warranty 860- 577 -7000 " FAX 860 - 577 -7001 FuN1er, in (10 ever .5th aJ {nliarator be responsible for any loss or damage In f 1 e Nowak Uro Uniis, w a y third party resullllig Ira[: with all �nslallalion or slap. 8�t) -221 mere, or tram any I),(". Iiaoilay claims of Roder or arty thud gaily. For this t. dtad Nra anry to apply, lyre lJnils :•lust tae instiWed ii accorrlLrco LL Sila CgnrJ ilon6 roqurrIXl ry slate and loCai wd %: alt Other dpJlCdue yw,.'. and 411iRrakir5 irr510Hatidl inalructluns. Idl Nu raalas0nlalrve UI {nfilhalur has the authority to r.hanyo U' axlexr thtc Lnnitadl Warranty No —A i,ty epptias (;',Any pally other than the origi. Pat Holder. Th9 eoove represents the Standard Limitre7 Warranty 011010d by Inflitrali A Iinidw number of elates and canines navy different warranty re4uire- ments. Airy purd>3snr Lit Units Should contact Iniilirator's Cur{>nfale Headquarters In Old Saybrook, ConrWk:ul, prdr to suoh pwchase, to obtain a sopy of the applicable warranty, and stwuid Can,!.ii read Ili warranty prep to the purchase of Units. U.S. Parents: 4,759,61 5,017,041; 5,156,466; 5,336,017; &401,116, 5,401,459; 5,511,903; 5,716,163; 5,565,776; 5,+339,844 Canadian Palenti 1,329,959; 2,004,564 Other pats i5 pending. ki ittrator Equalizer and Sida'Mrr r are registered tradernadl of :ntitUator Systems Ina lnfiltrahx is a teglstered traderark in France. Infiltrator Systems Inc, is a registered trademark in M C exico. Confour, ahoot Swivel Ccttb lecliw, Micrr.Leacfi!ng, PoIyL:H, SnapLock, ChamborSpacer, Posit-ock, Quickii Quicki'lay NECYCLEOPAPEP I r 1 691 ._ _,.._.... SEPTIC TANK E PUMP CHAMBER CROSS SECTION A ND SPECIFICA 4" CI VENT PIPE 12" MIN. ABOVE GRADE £ WEATHERPROOF 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE - WITH CONDUIT MANHOLE COVER FINISHED GRADE Wf PADLOCK & WARNING LABEL 4" Cl RISER ! � �4" MIN • 18 IN. 6" MAX. NL£T WATER TIGHT SEALS GAS- Ts'GHT , 177APPROVED A SEAL ' JOINTS WITH PPROVED --}— ; ALM APPROVED PIPE 'IPE V B ' '4N 3' ONTO ?NTO SOLID f ' 7 r SOLID SOIL TOIL 'PUMP OFF ELEV . FT. + OFF RISER EXIT D PERMITTED ONLY IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC f DOSE TANK MANUFACTURER: t�,,� NUMBER DOSES PER DAY; TANK SIZES SEPTIC �.S' (] GAL. DOSE VOLUME INCLUDING DOSE Bbd GAL. FLOWBACK: GAL. ALARM MAN'JPACTL�RER: ll�r. ,$� CAPACITIES: A = eZ INCHES a LI„ GAL. MODEL NUMBER: l,.V SWITCH TYPE: �0.c �' B = 2 INCHES = 4 a GAL. PUMP MANUFACTURER: G 1- C = INCHES GAL. MODEL NUMBER. F. U A SWITCH TYPE: ..JY'A eIL C: D = INCHES REQUIRED DISCHARGE RATE y 0 GPM PUMP & ALARM WIRING AS PER I LHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE IQ FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . 2.5 FEET + �Q_ FEET FORCEMAIN X :Z(.OFTf3.00 FT. FRICTION FACTOR S FEET TOTAL DYNAMIC HEAD w FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH �, ; WIDTH DIAMETER ---' LIQUID DEPTH� SIGNED: %-f z�°'.� -- LICENSE NUMBER: gq '� DATE: 1/88 GOULDS PUMP5 • Submersible Effluent Pump _.. 3871 EPO4 EP05 APPLICATIONS • Fully submerged in high 0 EP05 Impeller: Thermoplas- • Bearings: Upper and lower Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing following uses: lubrication and efficient improved performance, construction. heat transfer. • Effluent systems a Casing and Base; Rugged • Homes Available for automatic and thermoplastic design provides AGENCY LISTING • f superior h Farms manual operation. Auto, s +ape strength and oarrosbn • Heavy ry sum p matte models include du resistance. 9 . Canadian Standards As•odutim • Water transfer fMecltanical Float Switch a Motor Housing: Cast iron (CSA listed model numbers end Dewatering assented and preset at the for efficient heat transfer, in "F' or •C ".) factory. strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic C*alds wmys 4 I50 9001 bgla+nd. • Solids handling capabil FEATURES cover with integral handle and ' /4" maximum. ■ EPO4 Impeller: Thermopias- float switch attachment points. • Capacities: up to 60 GPM, tic Semi -open design with 0 Power Cam: Severe duty • Total heads: up to 31 feet. pump out vanes for mechanical rated oil and water resistant. Discharge size: Vh" NPT, seal protection. • Mechanical seal: carbon. rotary/ceramic - stationary, BUNA -N elastomers. • Temperature: 104°F (40'Q continuous 140 (60V intermittent. METERS FEET • Fasteners: 300 series I° i stainless steel, * Capable of running dry without damage to e *2.5 FTT -- components. Motor: s • EPO4 Single phase: 0.4 HP, v s 20 1150r2 V, 60 hz, 1550 RPM, built in overload with 5 automatic reset. 4 • EP05 Single phase: 05 HP, EP05 115 V, 60 Hz, 1550 RPM, 3 10 __- built in overload with automatic reset. 2 EPO4 _ • Power cord: 10 toot 5' standard length, 16/3 i _ SJTOW with three prong grounding plug. Optional 20 0 0 0 10 20 30 40 s0 GPM foot length, 16/3 SITW with three prong grounding plug — - -- L (standard on EPOS). 0 2 4 6 9 10 12 mI /h CAPACITY Goulds Pumps ® 2000 Goulds Pumps ITT Industries Effective February, 20M 63971 POWTS OWNER'$ MAN UAL & MANAGEMENT PLAN Page --IL of Z FILE INFORMATION, SY Tt;'NI SPECIFICATIONS Owner Parma Septic Tank Capacity ,2 al 0 NA ? 3 Septic Tank Manufacturer O NA tN:SIGN PAIiAMI;Tt Effluent Filter Manufacturer e � , 07 NA Number of Bedrooms +�{ (3 NA Effluent Filter Model l 0 NA Number of Public Facility Units, XN A Rump Tank Capacity aI DNA Estimated flow leverage) OO g al/day Pump Tank Manufacturer r� �, 0 NA Design flow (peak), (Estimated x 1.5) 6re1 d al/ Pump Manufacturer �,. / 0 NA �° at /da. Ift' Pump Model 0 NA Standard influent/Effiusnt Qudty Monthly average' Pretreatment Unit NA Fats, Oil & Grams (FOG' 00 mg /L 0 told /Gravel Filter 0 Peat Filter Biochemical Oxygen Demand (BOD.) 5220 mg /L ❑ NA 0 Mechanical Aeration ❑ Wetland Total Suspended Solids (TS&) 5150 mg /L O Disinfection 13 Other: Pretreated Effluent Quality Monthly average D)apat1w Came) ��` &. , O NA Biochemical Oxygen Demand (600 530 mg/L Ground (gray ja In-Ground (pressurized( Total Suspended Solids (TSSI 00 mg/L NA C3 t•Grade O Mound Fecal Coliform (geometric mean) 51 Q° cfu /100ml 0 Drip -Line 0 Other: Maximum Effluent Particle Size K in dia. 13 NA fir' 0 NA Other: 0 NA C NA * Values typical for domestic wastewater and septic tank effluent, ate ❑ NA MAINTWIAl110E SCNEDULE Service Event Service Fregasncy Inspect condition of tank(s) At least once every, 3 a s w (maxb m 3 years) 0 NA Pump out contents of tanks) When combined sludge and scum equals one -third (Y of tank volume O NA Inspect dispersal call(s) At ism once every: M h s) (VAWn um 3 years) i0 NA Clean effluent filter At least once every El NA Inspect pump, pump controls &alarm At toast once every: Cl month(s) 0 NA ( anon (e) p NA Flush laterals and pressure test At least on** every: -- t3 ear(s) Other: O month( &) ❑ NA At least once every: O earls) Other: Q NA MAINTENANCE iNSTRUCTiONS Inspections of tanks and dispersal cogs 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(*) to identify any missing or broken hardware, identify any cracks or looks, 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 cell(*) 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 (Y,) 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 Administrative 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, *halt be performed by a certified POWTS Maintainer. A service report shalt be provided to the local regulatory authority within 10 days of completion of any service event. 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Proper maintenan:c consists of pumping out the septic tank every three years or sooner, if needed b a licensed What y p umper, you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system, The property owner agrees to submit to St. Croix Zoning Deportment a certification form, signed by the owner arid b,: a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposat sys:c.m is in proper operating condition ant' ✓or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge Uwe (h undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standares set forth, heroin 8 P y as set et by the Department of C'ommcrcc and the Department of Natural Resources, State of Wisconsin. Ccrttfica {ion, stat 4Tijuo system s been Iita1;11;1 nCd niUS1 be completed and returned to the St. Croix County Zoning Office w,th:n 5C dayxpirat n date, SIGICANT 0 ' DATE OWNER CERTIFICATION ! (we) cc lha II statements un this form are inic to the best of my (our) knowledge.. I (we) am (arc) the owncr(s) of the pro desc [be ab c, by viriuc of a %�arranty deed recorded in Register of Deeds Office. SIGNATURE 0 PPLICANT /a9 DATE Any information that is mis•rcprescnicd may result in the sanitary permit being revoked by the Zoning Department. ••••'• '• Include with this application: a stamped warranty decd from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed U 2526P 003 756:506 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI STATE BAR OF WISCONSIN FORM 1 - 2000 RECEIVED FOR RECORD Document Number WARRANTY DEED 03/12/2004 10:00AM THIS DEED, made between St. Joseph Development Corporation., a WARRANTY DEED Minnesota Corporation Grantor, and Glen Johnson C onstruction, I nc., a EXEMPT t Wisconsin Corporation Grantee. REC FEE: 13.00 Grantor, for a valuable consideration, conveys to Grantee the following TRANS FEE: 275.70 described real estate in St. Croix County, State of Wisconsin (the COPY FEE: CC FEE: "Prop PAGES: 2 SEE ATTACHED EXHIBIT A Recording Area Name and Return Address: Land Title Inc. 1900 Silver Lake Road Suite 200 New Btig 55112 Together with all appurtenant rights, title and interests. 030 -2 2033 -40 -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 Dated this 11 th day of March 2004. St. Jose Development Corpo ation Kellei St. Martin, Vice President * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF Minnesota ) WASHINGTON COUNTY. ) ss. authenticated this I ith day of March, 2004 Personally came before me this I Ith day of March, 2004 the above named Kellei St. Martin Vice President of St. Joseph * Development Corporation, a Minnesota Corporation to me TITLE: MEMBER STATE BAR OF WISCONSIN known to be the person(s) who executed the foregoing (If not, instru t nd acknowle ed thq sam . authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY m Notary Public, State Minnesota My commission is permanent. (If not, state expiration date: Greg Booth Attorny 1900 Silver Lake Road Suite 200 New Brighton Mn 55112 (Signatures may be authenticated or acknowledged. Both are not necessary.) LENTZ *Names of persons signing in any capacity must be typed or printed below their signature NANCY J. NOTARV PUBLIC MINNESOTA My Comm. Expires Jan. 31.2005 WARRANTY DEED STATE BAR OF WISCONS No. 1 -2000 ■ U 2526 P 004 EXHIBIT A Lot 15, Settlers Glen located in the Town of St. Joseph, St. Croix County, Wisconsin. Safcty and Buildings Divisiun TCcunty '1 Washington Ave„ P.O, l3ox 7162 sC tadisod, WI 33707 - 7162 Sanitary Permit Number (to be fi cons in fi lled in by Co.) Department of Commerce (tea) 2 N. Sanitary Permit Application State Pin 1,D. Number In accord with Comm 83.21, Wis. Adm. Code, personal inf matlort dhrovidi may be used for secondary purposes Privacy Law, 5.04(l)(m) j Project Address (if different than mailing address) i. Application Information - Pleane Print All Informatian f_.ONING OFFICE _� C )&3 Property Owner's Na the Pare Lot N SleckiE_ Property Owner's M ailing Address Property adon �'' = '� .Seetion I City, State Zip Code Phone Number 1�--- �� J� ll/ �,.�`,,$ 6 � rS.�/' J✓ % .� / T (cirole o ) J iI. Type of Building (check all that apply) � S � �O N: R �(� B o� t or 2 Family Dwell Subdivision Name C M Number ng - Number of Bedrooms S - �. ❑ Public /Commercial - Describe Use ❑ State Owned - Describe Use I ❑City_[]Village Township of III. Type of Permit: (Check only one box on line A. Complete l ine B if applicable) 030 — 2� — — COG I LYp A ' ' System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal C1 Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that apply) Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil Q Mound < 24 in. of suitable soil ❑ At -Grade it Single Pass Sand Filter f ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculadnit Synthetic Media Filter � ZLeaching Chamber rip L' e ❑ Ciraveldess Pie ❑ 0 er (explain) , V. Dis: rsal/Treatment Area Information: " - : p L Design Flow (gpd) Design Soil Application Rate(gpdsf) Disparsil ATef Required (sf) Dispersal Area Proposed Of) System Elevation C� Ir, �S7 r IFS5 �. _�_ ____�__ ___ VI. Tank Info Capacity in Total Number I Manufacturer T Prefab Site Steel Fiber Plastic Gallons Gallons of Unite I Concrete Construcced Glass New Existing j Tanks Tanks Septic or Holding Tank i /a66 l zo � e✓ 1 M Aerobic Treatment Ueit Dosing Chamber i G VII. Resporuil.bility Statement. I, the undersignsid, assume responsibility for installation of the POWTS shown on the attached ' Plumber's No me (Print) Plumber's Si gnatu MP /IrtPRS Number Business Phone Number Plumber's Addre ss (Street, City, State, Zip Code) i VIII. County/Department Use Oni i Approved C1 Disapproved Surchar Surcharge Fee {includes Groundwater Q ate Issued I sui Agent Signs ter Nu Stamps) I , ❑Owner Given Reason for Denial g 2 � — �� I IX, Conditions of Approval /Reasons for Disapproval 3 S, SYSTEM OWNEk _ ��w�TS� 1 Septic tank, effluent filter and N � r / maintained i dispersal cell must all be servlc ed �_ as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances Attach tomplets plant (to the County only) for the system on paper not less than sl/2 s it inehu in slat RTl -6 t rte n 1 /mi i 3 l oo � to >e 73.&b S - \ r 1 1 \ / 3 .l Ss r I r - Wiscon:jt6 Department of Commerce SOIL EVALUATION REPORT Page of 3 pivisiml 6f Safety and Buildings 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 C TO 1 include, but not limited to: vertical and horizontal reference pant (BM), direction and parcel I.D. 6 J percent slope, scale or dimensions, north arrow, and location and distance to nearest road. — p �LU 231 — /S- 0 Please print all i o r _ e1"e Da L A t s. 15 (1) (m))• G��V �' v '^- u Personal information you provide may be used for ary purposes (� P rty Location Property Owner '' �' 2001 Go r e Lot S, 11450 114 S 23 T 3L) N R 2.Q E (or� , S Property Owner's Mailing A s y 1 Lo j# Block # Subd. Name or CSM# ccl City State Zip Code Phone Number City ❑ Village Town arest Road aver -IN N 22 ( ()y 3q1 (41C4 �t _ Joy s ® New Construction Use: ® Residential / Number of bedrooms _ y Code derived design flow rate y�l o d d GPD ❑ Replacement ❑ Public or commercial - Describe: Q U +W 0 S � Flood Plain elevation if applicable /�/ /� Parent material ff General comments s ✓V1 and '7 recommendations: � y � Z /0 Y V b U ° 7c, r - br— , — f i� , t/b/.{� � tr� — s I Boring # Boring El pit Ground surface elev. q?� ft. Depth to limiting factor i ' �)O in. Soil Application Rate 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 I o -10 10 V r CS Z I - �� C� �i l Z � cS -- • 5 . � I q r c4 co Q mI — -- .� l.Z Boring # ❑ Boring pit Ground surface elev. l U�) . ft- Depth to limiting factor 134o in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 Z 13-55 10 - ,N (p ,5 -4 � 3 .go • 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) gnature CST Number Sch m 2,5330q Address Date Evaluation Conducted Telephone Number S�r�Se� lol � 8=/� °z L7I5 )7-q7 -yU)36 Property Owner Parcel ID # Page • 2 Boring # ❑ Bong Pit Ground surface. elev. tt. Depth to limiting factor 131 In. Horizon Depth Dominant Color Redox Description Texture Struck" Consistence Bou Soil Application Ra In. Munsell au. Sz. Cone Color - rY Roots GPDtW Gr. Sz. Sh. •Eff#1 . •Eff#2 0- lb r 13 c S ► v f 5 8 CS 3 _131 10 yj� F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rai Horizon Depth •Dominant Color Redox Description.., _. Texture - Structure Consistence Boundary Roots GPD 111' In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. • Eff #1 • Eff#2 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev, ft. Depth to limiting factor In. Soil Application Rats 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 = BOO$ > 30 < 220 mg/- and TSS >30 < 150 mgA., • Effluent #2 = BOD < 30 mcyh 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 TT y 608 -264 -87 SBr -1130 (R07A0) 1 PAGE OF 3 NAM E Ca rr, a ! LOT# s LEGAL DESCRIPTION SW X 4 ,S Z 3 T 3o Nan E(orm SCALE: I"= YO BM I ELEVATION Od , BM I DESCRIPTION 4p�; 0%D c- BM 2 ELEVA'T'ION O BM 2 DESCRIPTION bn a� j 1, - - -- - -- - SYSTEM ELEVATION SYSTEM TYPE ODA u cnbbv� CONTOUR ELEVATION V,00 J- /00 0 (� 4V Q cl �o �d d 6� C DATE SIGNATURE a. ; x ti �INi �xp ' M1,N, A80vE G:�ADC b F ROM book I WI ItiDOW pR �►Ek1 R '�?ERAQOF FA M AYR ;NTAKE JttI NEAP 30.X A Mot? ED FINISH£« GRA 'W2:' G� Buz;° .UNPOU CovER ! u" CT RISL�'A R1 PADLOCK i " :.ABED, wa l iN• �,,� u Fi :X, i� i � r L ° WATER TIvKT SF,ALS GAS TIGHT ' ;PpR A SEAL PROVED )IPE 31 , � ,,,� JOINTS WITH AP P 14 V I D P 3NT0 Sit ID � _ t on 3' am ;O.l � i SOLIO, SO1l. P;�MP CFA' ;LEV , FT ** R ISER EXTT D 3 PERMITTED CNLY IF TANK MANUFACTURER ►, APPR $EDD NG U:1DER TA?�tK MAS APPROVAL �« . �PECIFICAT:CNS pONCRETE PAD TIC r DQ3X 'ANK MAN'JFA "TJR£R: ' OS£5 PER DAY S£r'^ +C ,DOSE GAL, +OSE vC;tt1.*1E IAC;,:.lD_TNG F LOWSAC K s t 9 GAS, . LARK MAtV'JFACTt;R£R: i CAPAC MODEL Mil lack; T IES: A „ INCKIS SWITCH TYPE: MANVFACTVRER ..... -GAL MODEL NUMB SWITCH '1'YPF: "� - ,,.,.,� INCiIES s !�' GAL. DISC HARGE R, - .LING...... . AT 14% PUMP E ALARM W—R * NG AS rER Z Lh'$ R+:CAL DIFF£RD,11C gE s 26.23' WA'. �'TNI'rtt�M NETWORK SUPPLY PR£EOF DISTP?Btt;SON PIPE , F ?� 10 G F .. f R: C T: ON FACTOR ... FEET ,ma T M OTAL DYNAMIC FL"LT .rRNAL DZMI;;��S :oNS I:AD ; - ....'r.. WIDTM ,,~- r�+ .;7 b M" [qGOULDS PUMPS Submersible Effluent Pump 3871 EPO4 EP05 APPLICATIONS • fully submerged in high ■ EP05 impeller Thermoplas- ■ Bearings: Upper and lower Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing p y g lubrication and efficient improved performance. construction. following uses: heat transfer. • Effluent systems ■Casing and Base: Rugged thermoplastic design provides AGENCY LISTING • Homes Available for automatic and superior strength and corrosion • Farms manual operation. Auto- Carman Standards Assodatioo • Heavy duty sump matic models include resistance. _ • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end • Dewatering assembled and preset at the for efficient heat transfer, in "F" or "C ".) factory. strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic Goulds Pumps is ISO 9001 Registered. FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. 3 /4" maximum. ■ EPO4 Impeller. Thermoplas- 0 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 NPT. seal protection. • Mechanical seal: carbon - rotary/ceramic - stationary, BUNA -N elastomers. • Temperature: 1041(40°C) continuous 140°F (60°C) intermittent. METERS FEET ....................__.._.... ..... .........:................ _.. 10 j • Fasteners: 300 series i..... 3 • i stainless steel. 9 - ---- -� sG -- • Capable of running 30 .. _._..__ _____ __._. ___.._. _. FM . dry without damage to $ �25 components. .. 0 7 y Motor: _ • EPO4 Single phase: 0.4 HP, u 6 20' 115 or 230 V, 60 Hz, 1550 a RPM, built in overload with c 5 15 automatic reset. _j 4 ¢ EPOS • EP05 Single phase: 0.5 HP, o 115 V, 60 Hz, 1550 RPM, 3 10 — built in overload with EPO4 automatic reset. 2 _ .. ... • Power cord: 10 foot 5' standard length, 16/3 1 ...... S1TOW with three prong grounding plug. Optional 20 ° 0 0 10 zo 30 ao 5o GPM foot length, 16/3 SJTW with three prong grounding plug 0 2 4 6 8 10 12 m (standard on EP05). CAPACITY Goulds Pumps ®2000 Goulds Pumps ITT Industries Effective February, 2000 83871 - � Quiclfr4rAf STAMl CHAMBER Quick4 Standard Chamber - - - 48" - - (EFFECTIVE LENGTH) —' t 1 -- -- ® - I � r — 34' — SIDE VIEW SECTION VIEW MultiPort End Cap �- -- - - -- _ t t s• t I SIDE VIEW TOP VIEW FRONT VIEW Quick4 Standard Chamber Nominal'Speeitications Multipart End;Cap;Nomnai'Specificatlona .R r ... Si ze WxLxH - � -- _ Size W X Cx H 34" x 16" x 12" Effective Length 48" Invert Height 8" or 1.25" ' Invert Height g" INFILTR SYST EMS. INC. STANDAR f_IlYlI_TED WARRANTY srq eg - .ly 0t each thaws And plate, wedge and other accessory msrvart'sed by it squalor ( "Units', when iostaf4d anti niol led leacnreld o! ons to seetu: Syst in accordance w' or' .Ih hfiltrats nstrui,11ons, k warra� tad to the nngiinal p� baaer CHrldsr' egafnat rtefActtve ,n alenalA anA workmansl•dn iv ens year Ii the date that lho VptC permit Is'S5I1er7 Ijr the septic SYSlout conlairnng tow (1019: provided, however, that it a septic perms is rot reguirad by appfrabte taw, the warranty period will oagin upon the Aate that mslallahon a the septic system Cc Imenwe. To e"Ol lsA its wa anty rights, Hokier must notify Infiflrator in writing at its Corporate Headguaners In Old Saybrook, Connecticut within fi'taen 115; days of the alleged detect. Infiltrator 01111 supply Wlacoment Jbits for unite determined by Inluraror to be covered by this Umtted VJarrarty. • Inlltratc,,'s liability spsfiticalY excludes the cost at removal andior instaliaoor of rho VPlts, &V I i �hI THE`. t.IMITfD WARRANTY AND REMEDIES IN SU113PARAGRAPFI (a) ARE EXCLUSIVE. Triii ARE NO OTHER WAP3ANT'ES WITH RESPECT O TO THE uNl fS, INC! 11DING NO IMPLIED WARRANTIES OF MERCHANTAp1Lrh'' OR FITNESS FOR A PARTICUJR PURPOSE. �YSTE M S INC (r,) Iris bridled Warranty shall be void d any Part of the chamber system ,s mdnufacl ireA by ll na ether Ihari InAllralor. The I irnilecf Warranty does `—,J .,,A a %lend to rnddentah consequertltal, special or indirect damages. h iltratrn ah:.al rat be habIL la penalties or liquidaf: J darnagea, rcludirrg less W Environmental Onsite Wastewater Solutions` vadixkion antl p offt labcr and ntalaials, overhoad costs. u' other losses or ..Pen. rrai b vy, HMdw or any third oanv Sprx;ifraNy r cl.scli from L roiled Wa!ranty clrvoraga are damage to the U'its due to 0nfra was antl tear, allerat'on, aGC:eleni r :use 81 or oil (if the east the j" IS bA"'g subid7ted W vehicle impil or Oohs 00bdrltars which are not r .miffed by the mstallalier, irtit uctionsi f5li to maintafl the 6 Business Park Road • P.O. Box 768 minimum grog nd 0OVers set forth in the installation inatYUglkrl9, the plaoMnent of a Proror materials into the ayslerl cdnlalrNng !re Units: IaiArre 0. 110s Units or the sAP1c system due to improper sling or Improper sizing, wooss,va water ,,,age, i^tprDpdr g ",sae ditgr�al, rr imtrrri0er Wera16U11: rx Old Saybrook, CT 06475 airy o0" ther e=t not ca� by InMrator. firs Limited Warranty shat be Void it VIA Holder fa +IS 10 compN with all or VIA term: sat Iorth to ens Limited We, ably. 860-577 -7000 " FAX 860- 577 -7001 Pi rthA , in rn evorn halt k.fllmtar n b , responsible for any loss or damage to the H7klor, he Trots, or Sh y third party resulting from installation nr ship- p UU -22") n�f - 4436 mern or Iro any c oduct latrltly trbs of Haider ca any third Party. For this La�AfKf War anty to appn y the Units must be installed in accordance with all sea cendtrnv requoi by state and local codes: of other apPlbatde laws. end InE1 ratcr ; inclaltat on 10strudkNts. 8 (d) Nn !1MS4ntb of Irfl trakv has !I:e :utthurily to change nr aidond this Lirnled WVammty. No warranty applies to any p�N nfhar than "A He the origb Helder. Tire above rep,asonlc the Standard Limdc 1 Wany an' 0i by Infltrater. A "Ali) nrmber of states and co, nVe, h r+e di!lerent warcanlY re7rrim- marns. Any purchaser o f Unrls snrrutd contact Infilfrator's Gorpgra Headnual 'S in Olt Saybrr»k, 00nrerYicut, p rior in such purchase, to obtain a cnriy of Pte Applicable warranty, and should canitli read that warranty pnOr to the burchase of Units. U S. Patents: 4. 5,017,041; 5,158,488; 5,33G,017; 5,401.116; 5,401,459; 5,511,903; 5,718,1(';3; 5.598,778; 5.839.a44 Canadian Patents: 1,329,959; 2.004,564 Other patents pending. Infiltrator, Equalizer and SideWtndar are registered tradernarks of Infiltrator Systems inc. Infiltrator is a registered tradernark in Frai li ffltratcu Systems Inc. ,5 a registered traderlarK in MBxiCO. ContoL r, Contour 5wlvel Conneeion, WIrol_aaching. PolyTuB. SnapLxk, ChamberSpecer, PocnLdok, Q"KCut, OutckPlay c4LD nnwrn and Cu+ck4 are traderni of Wiltrator Systems Inc. ID 2003 Infiltrator Systarns Inc. Printed in U.S.A. 0011203;;° D L POWTS OWNER'S MANUAL. & MANAGEMENT PLAN Page of FILE INFORMATION Septic SPECIFICATIONS Septic Tank C &PacitV ,� d a! 0 NA Owner '. . t Permit # Septic Tank Manufacturer 0 NA Ot'r.8ION PARAMETERS Effluent Filter Manufacturer �' 0 NA Number of Bedrooms 0 NA Effluent Filter Model d' d NA Number of Public Facility Emits `OVA Pump Tank Capacity ai 0 NA Estimated flow (average) __ A alld sy Pump Tank Manufacturer Zd t7 NA Design flow (peak), (Estimated x 1.5) 6" 61 d - gavey Pump Manufacturer L IZ 0 NA Soll Application Rate al /d ttt2 Pump Model 0 NA Standard Influent/Effluent Quality Monthly average' Pretreatment Unit Fate, Oil & Grease (FOG) S30 mg /L 0 Sand /Gravel Filter 0 Peat Filter Biochemical Oxygen Demand (8013 5220 molt 0 NA 0 Mechanical Aeration 0 Wetland Total Suspended Solids (TSS) I s 160 mg /L 0 Disinfection 0 Other: Pretreated Effluent Quality Monthly average Dispersal Cents) DNA Biochemical Oxygen Demand (BOD 930 mg /L *_ln.Ground (gravity) 0 In- Ground (pressurizedl Total Suspended Solids (TSS) 00 mg/L 13 NA 0 At -Grade 0 Mound Fecal Coliform (geometric mean) 510 cfU /100ml © Orip -Line 0 Other: Maximum Effluent Particle Size Y In dia. 0 NA Other: 0 NA Other: 0 NA Other: 0 NA • values typical for domestic wastewater and septic tank effluent. �' I7 NA MAINTENANCE SCHEDULE ffien+il" Event Servics frequency Inspect condition of tanks) At least once every: a) a (Mizidmurn 3 years) 0 NA art Pump out contents of tank(s) When combined sludge and scum equals one-third IYa) of tank volume 0 NA Inspect dispersal call(s) At least once every: monthts) (Maximum 3 years) I7 NA ,q ear(a) Clean effluent filter At least once every: j ,''JrY serfs) moft10 (3 NA inspect pump, pump controls & alarm At least once every: �,.... month(si 0 NA Q ear(s) Flush laterals and pressure test At least month(s) 0 NA t once every: p y wal Other, At least once every: 0 � th(s) 0 NA Other: _ Q NA MAINTENANCE INSTRUCTIONS tnspecticne of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Masser Plumber Restricted Sewer; I POWTS Inspector; POWTS Maintainer; Septage Servicing Operator, Tank Inspections must include a visual inspection of the took(&) 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 coil(s) shall be visually inspected to chock 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 (y or more of the tank volume, the entire contents of the tank shall be removed by a Septsgp Servicing Operator and disposed of in accordenoe with chapter NR 113, Wisconsin Administrative Code, All other services, ktClUding but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 57 2 months, Shall be performed by a certified POWTS Maintainer. A service report shall b e provided to the local regulatory authority within 10 days of completion of any service event. i I •apaa en11BJ18luilupb ulsuoaslM '!£) R (Z) '(0V9 PUe ll)'BIR)l t)lg)IZlZZ'£8 wwoo MO 4UM eousl)dw u l pe 4eip gem wroinoop SPl1. ' au04d Ouo4d AIRIONIM AN01Vinew 1V001 4i3dWN1d) d01V!l3410 0NIMAl13S 31DV.Ld3S au04d auo4d N� 1i3NIVINIVW s1MOd U31WISNI 81MOd S1N3WWW 1VNOliMV '318)SSOdwi vo liOO)ddlia 38 AVW 1INV1 V d0 VOI}N31NN 3H.L NOW NOSWU V d0 3nosm 'iinsau AVW Him '83ONV1SINnOala ANV MGM XNVI 1N3WLV3Vi V31410 Ho dwnd 'ON.Ld33 V Il31N3 SON O(3 "N30AX0 J1.N3iawanSNl H010NV $39SV0 1VH131 NIVIN00 AVW S )INVI 1N3W1V3H1 H3H10 ANV 4VVnd '0LLd3S < <DNINUVM> > - p w !i 1041 1$ lopgo ul salru 941 pm Aldwoo lsnw sweisAe flans ;o cuotlonJieuooell •9o9 ;ins 9AlIO J11I;U! 941 le lewolq e4l ;O leAOw9J Buimollo; weld ul pelonulsuooeJ eq Aew swe lsAs u olldJosge 1!09 ep9J8. pus PUMA 0 e �uei ks 1 0 slls pus Roa 51MUC X 1. 7 1 . 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I L - ✓ (Verification required from Planning Department for new construction) City/State Town of St. Joseph, WI parcel IdentificaCon Number See Attached Deed JX 0, DESCRIPTION Property Location NE V., sw t /4, Sec. 23 . T 30 11_IZ 20 W, Town of S Josep Subdivision Settler's Glen , Lot # , Certified Survey Map # . Volume . Page # Warranty Deed # 7 0 0 5 6 9 Volume 20(o S � Page ft` 5 Spec house ❑ yes N no Lot Bates identifiable ❑ yes ❑ no SYSTEM MARTMNANCE . lagmper use and maffitenancr of your septic system could result in. its Fremsbue failure to handle wastes. Proper fiance consists of pampiing out the septic tank every thew years or too=. if needed b- a licensed Pier. What you put into the system can aged else fim+ciion of the septic tank as a tnatn ent stags in tic wsste disposal system. The property ova= agrees to submit to St. Croix Zoning Ducat a certification farm, sipcd by the ownar and by a masterplmmlxrjourneymanptumber, tmtrictodplumber or a licensed pauper verifying that (1) the on -site vastewaterdisposal system is in proles operating condition and/or (2) after inspection And pumping (if necessary), 6e septic tank is less than 113 full of sludge. Uwe, dw mndcrsi C have read the above n;quirements and ague to maintain the private sewage disposal system with the s=darcts set forth, herein, as set by the Department of Commerce and the Department of Natural Rcsour ccs, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the year expiration te. t1G NATURE OF CAN'T DATE OWNER CEATMCATTON I (ere) certify that all statements on this form are true to the best of my (our) knowledge. 1 (we) am (aar) the ow'ncz(s) of the property above, by virtue of a warranty deed recorded in Reester of Deeds Office, //// O Sl ATTIRE OF APPLICANT DATE s « «s «s A information that is mis- mprc=tedmay result in the sanitary penult being revoked by the Zoning Department. " •• Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey neap if reference is made in the warranty deed '1 2065P 598 KATHLEEN H. WALSH Document Number TRUSTEE'S DEED ST. CROIX 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 RPC FEE: 13.00 County, State of Wisconsin: TRANS FEE: 4390.60 COPY FEE: CERT COPY FEE: PAGES: 2 See attached addendum. This is homestead property Recording Area Name and Return Address LAND TITLE INC �. 1900 S ': - * . ` . ` . .. � .OAD Ne.l 6 Fi iv(1 �v ., NIN 55112 ALE NO. I I - 1 q / J 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 day of 2002. *Henry J. L Trust " " Bemire A. Lentz AUTHENTICATION ACKNOWLEDGMENT Signature(s) 2 a ✓vJ 7 ^ r r STATE OF WISCONSIN t`� f` n 1Y'Q -. !'I � l Q �� YZ ST. CROIX COUNTY .11 Personally came before me this _ day of authen ' ted t is a � k day of rl 0V �� • 2002, the above named Henry J. Lentz, as Trustee of the A.C�Y Henry J. Lentz Family Revocable Trust, and Bernice A. a'LJ I Lentz, to me known to be the person(s) who executed the signature r 4-?v t3 foregoing instrument and acknowledge the same. �'�-� V�/A -� c� 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 TrusteesDe edStJosephOevelopment -02 J 2065P .5`i9 Property Description - (Henry J. Lentz Family Trust /Grantor to St. Joseph Development Corporation, Grantee) A PARCEL OF LAND LOCATED IN PART OF THE NW1 /4 OF THE SWI /4, PART OF THE NE1 /4 OF THE SW I/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 114 OF THE SE 1/4 ALL IN SECTION 23, AND IN PART OF THE NE 1/4 OF THE NW 1/4 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 °59'28 "E ALONG THE SOUTH LINE OF THE SEI /4 OF SAID SECTION 23, 1329.95 FEET TO THE EAST LINE OF SAID SWI /4 OF THE SETA; THENCE N00 °05'53 "W, ALONG LAST SAID EAST LINE AND THE EAST LINE OF THE NW1 /4 OF THE SE 1/4, 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 °15'03 "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 °17'14 "E A DISTANCE OF 304.14 FEET; THENCE N89'4 1'28"W A DISTANCE OF 404.95 FEET; THENCE S00 °1 7'14 "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 1 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 NE 1/4 OF THE NW 1/4 OF SECTION 26; THENCE N89'5 5'00"E, ALONG LAST SAID SOUTH LINE, 66.08 FEET TO THE WEST LINE OF LOT 1 OF CERTIFIED SURVEY MAP RECORDED IN VOLUME 5, PAGE 1352, AT ABOVE SAID OFFICE; THENCE NO2 °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 I OF CERTIFIED SURVEY MAP RECORDED IN VOLUME 2, PAGE 348, 521.61 FEET TO THE NORTH LINE OF LAST SAID LOT 1; THENCE S89 °53'49 "E, ALONG LAST SAID NORTH LINE, 894.17 FEET TO THE EAST LINE OF LAST SAID LOT 1; THENCE SO4 °28'32 "E, ALONG LAST SAID EAST LINE, 523.40 FEET TO THE SOUTH LINE OF THE SW 1/4 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. 35164 AND C.T.H. "E" AND SUBJECT TO ALL OTHER EASEMENTS, RESTRICTIONS, AND COVENANTS OF RECORD. ' 3 j N67WO9 "E 86.5 TO CENTER OF CLUDE, OF THE SW1 /4 y \ c) I 1/4 OF / \ \ N89°5 07 "E 82.16 THE SW / c _ _ 80 RADIUS T OF SECTION 2b / rs � $ EASEMENT BE WISCONSIN. / d �/ • � 89 °54' 7 ' 82.46 ROAD EXTENSiOty — o cam/ \ � 16.46' \ 4 � /SEE DETAIL \ ' ON SHEET 4 , . �0 0 \ .•?y n i LoT 15 - _ \ "� •'\ / 130,681 SQ. FT. I C T �. • �. s 90 I� .000 ACRES 0,682 SQ. FT. CONSERVATION ( „� � •'� • \EASEMENT • . �7,p • c • .\ \ \tea. I !�n 0 LOT 30 �� �� LIOT 1 4 \ I O 3.000 ACRES } \ 3.000 ACRES • • �;. 130 682 SQ. FT. ' ca 130,685 SQ. FT. p . \ \.�,• I 240.73' 46 >2 \ ....... .............................:v A '•74' 223.01 1� \ L11 264.92 _ 1329.95' )' 28 " E 1329.95 � n N89 0 59'28 "W 2659.90' \ 2o , RECREATIONAL TRAIL EASEMENT ------- - - - --- � ��e„/ �d�.V�orJ C oti .Z a fil'� �.s ���e- �'S / /,� -�,✓ S/"�/v5'�i� � I I � I i i I i I I f i �I I ysQw��� x ys II � I� I CA I Wisconelnpeparlr stentotCominet�e SOIL EVALUATION REPORT Paseaf mision of Safety and Buildings In mcordattce with Comm 85, Wts. Adm, Code ' county 51 , — Attach complete site plan an paper not less than a 1l2 K t 1 inches in "re- Plan must include, but not Rmited to- vertical and tw rizorntal raference point (BM), diruction and penal 1.0 percent slope, scale or dimarimorns, north arrow, and lecection and disianoo to nearest road. Reviewed y Dato Ales as pr int sit Information. b con u ea Pave law, S. 75.44 (r) (mil. personal infoMtellee you provide may AO used for to dart p n� ( cY Property Own er — .Property LoccaUor _� Govt. Lct 10`4 114 S T N R E (or) w PtopettyQwnefs M ailing Address Lot 11 f3bdt # Sukid. Na ne ' CSMA e.r5 State ("ode Phone :1 ❑ V City IKage PTiwr Nearest Read ( ) vsz. h LA14L -- — – 'j -O (;Po New Constru tiort Use: Residential I tyumber of bedrooms Code derived design tlow rate. ❑ Repiacomert Pt tbiio or mmmerdal - Describe -- 1 5�� _ f=lood Plain elevation if opplicabie -- =� -- R' General c amrmrd5 �r� C��erh e e u , and recommendations: ❑ l3arxtg M Baring # Pit Ground riacE elC�v. '` d ft. Depth to limiting factre in. $ gii Application Rat¢ Ho&.on Depth Dominant Color Redox Deecrptlon Texture 51-- joiures Cpnaisienae 9oundary Roots *Eff#1 'Eff#2 th Mqq Qu. 5r. Cont, Cdor Gr. Sz, S h. o yYY(6- C S (u C C3 C >..5 YN - Q G i t3oring P fl Pr Borrng / in. L Ground steam e!ev. k. Depth to limiting factor �/ Sol ication Rate tiosixon Depth Dominant Color Ftedox Description Texture Structure Consistence Boundary hoots E GPD 'EttYt2 ftl in. Munsel Qu Sz. Cont. Co lor Gr. SZ. Sh. - v r(v 40 11 1 ! r 0 5 US ��✓ t 1, l ' ERlt W #1 = BOO a 30 5 720 mgfL and TW ;-30:5 1 150 mg& ' Eflimnt *2 = BCD S 30 n& and T$3 30 wWL CUT Nm1w CS'" Name (Please � � f7� � OaCALI A* Addrocc Dale Evaluation —Cnduaed Takcphane Rumber r,/ l -7 0 `( L) -S- 71_r- - j�P` 4 � 9 Ed Wd I : 50 SOIDE 60 • F rill rn.i XS j w0dj C & -2 p -- a V /� U 2e 1 Eftivar>t !!1 _ 80D r 30 t 22D MIA and T% >3o a 1511 rr�/L • MGM 02 Name {Please Pr O Bi)U CM ` � rnBl1 and TSS < 30 r%& re dress CST Dace Evahtatfon conduc6ed T elephone rrtmeer - - -.. . LWA r - G Wing # ❑ f3oring [] Pit Ground surface elev. ft. DsP� to limiting Tactor in Soi' tion Kato Horizon Depth Dominant Cdor Redox Description Te*ara Structure Consister)ea Boundary Roots GPDHf In MwWal, tau. sr. cant. Cofer tar. S4 Sh. •EthMi 'Hffli2 # p Basing ❑ Ptt Grgcrnd surface atev. ft. DePM is Nrnfting Eaotw In. ioadon Rato Horizon Depth Dominant Redox Desorfptiun- Tsarciwe Strucpxe consistence 6a nde+ry Roots -GPb "Etf42 In. Munselt Qu. Sz. Cant. Color Gr, $2- Sh. s 30 BOd , t 30 and 1'SS _ tnglt- > e 220 ettd TSS >3t) < 150 rngtl. ' Edfuenl #2 _ mglt. S1ltuent Ni = Bt7D 30_ mgl� _ a The Department of Commerce is an equal oppottanity service provider attrl employe,. If you need assistance to access services or need material in an alternate format, please contact the dcpartmcnt at 608- 266-3151 or TTY 608 - 264 -8777. SSD -t)30 �0.dW) Ed Wd0c:60 S00z 00 ' 'ON i;irJ WMJJ