HomeMy WebLinkAbout030-2131-16-000 F °Vis-onsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
453131 0
GENERAL INFORMATION (ATTACH T6 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:
St. Joseph Development Corp. St. Joseph Township 030 - 2131 -16 -000
CST BM Elev: Insp. BM Elev: BM Description: _ Section /Town /Range /Map No:
CST BM Elev: Insp. BM Elev: 7 — � Cm`s \ 23.30.20.1070
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY TATION BS HI FS ELEV.
ccd e ( n04 - Lle+- g S
Septic Benchmark
/S5 �. raz 98 5'a
Dosing / �v Alt. BM ccCr a>` p,f
Aeration / () Bldg. Sewer ��� I I
Holding St/Ht Inlet I 3 w, �sS
TANK SETBACK INFORMATION St/Ht Outlet 0
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic 7Z 3 i N /L C7 1 I �_ Dt Bottom I � $Z -d5
Dosing i Header /Man.
Aeration Dist. Pipe
J, Q ,r L
I `r'
Holding Bot. System
Final Grade
PUMP /SIPHON INFORMATION 4. 7-6
Manufacturer Demand St Cove C,
v� GP 1 &,J, j1, 5
Model Number
TDH Lift Y 3a Friction Loss System H d TDH Ft
Forcemain Length i Dia. fl
r z s z I Dist.tow e ll / �'!�—
SOIL A BSORPTION SYSTEM
BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid epth
DIMENSIONS 7
SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of System: UNIT Model Number: ?� 1
DISTRIBUTION SYSTEM
Header /Man Distribution x Hole ze I x Hol Spacing Vent , to Air Intakm
/ Pipe(s) \ \ /
Length Dia_ Length Dia Spacing �( r
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only GS+d C u
Depth Over Depth Over rx Dept of xx Seeded /Sodded xx Mulched
Bed /Trench Center r Bed/Trench Edges Topsoil
�S1 Yes No Yes No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: / /
Location: 161 Heritage Tr Unknown (SW 1/4 SE 1//4 23 TT30N R20W) Settler's Glen Lot 16 Parcel No: 23.30.20.1070
1.) Alt BM Description = Sar Ced..A.� bb d v' "t— _ �; V 1 pc
2.) Bldg sewer length = 1'- i
- amount of cover = /
3.5
!�
Plan revision Required? Yes No g
Use other side for additional information. U _
' Date Insepctoroignatu Cent. No.
_ SBD -6710 (R.3/97)
r 'v,
�� -- Safrty and Buildings Divisiun County i
2C1 W. Wa 4 '_ P Q BOX 7 162 ��Z_�l!d
� �a���� Mad 1, `� ���$�� Sanitary Permit Number (m be filled in by Co.)
Department of Commerce (60 8) 266- Lf J � 3 I
• •' • State Plan I.D. Number
Sanitary Permit App1 ati i I
In accord with Comm 83.21, Wis. Adm. Code, 1pe al, In ormation you provide _
maybe used for , i
secondary uses Privacy La s15.S�1 t Address if dif ferent than mailing address
Y Y p�'P Y (Utz,. ; , ;;,ii,, J r'- Prosec Addy ! iffe t g )
ZONINt; �
1 1. Applic adon Information -- Please Print All Information ( (O 1
Property Owner's Na me I# Lot K R*"
.5 aS"
�v -% / — I
Property Owner's M ail Address Property Location
City. state Zip Code Phone Number 4 ° 5 ;�f'1A.Section j
A e- ,?F1 Ins � - ,� (Circle Oil '
II. Type of Batgding (Cheek all that apply) T .�d N; R d
ao S�w.�
tgl or 2 Family Dwelling - Number of Bedrooms S (qt t Subdivision Name FM Number I
❑ Public/Commerciel - Describe Use SG B y s
State Owned - Describe Use CCit ❑Villa a Ofownshi
_ Y _ p of g 4tct cs'
- Tom' 14
III, Type of Permit: (Check only one box on line A. Complete line B if applicable) 030 — 2 — —per , 11D �p
A.
New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement only r Outer Modification to Existing System
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of u Pcrmi[ Transfer to New List Previous Permit Number and Date issued
Before Expiration Plumber owner
' 1 \
` L IV. Type of POWTS st em: _ (Check all that apply) y
Non - Pressurized In- Ground :J Mound > 24 in. of suitable soil L1 Mound < 24 in. of suitable soil iJ At -Grade ❑ Single Pass Sand Filter '
❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank C Peat Filter ❑ Aerobic Treatment Unit L� Recirculating Sand Filter
❑
Recirculating Synthetic Media Filter VLeaching . Leaching Chamber t.. DripLine Gravel -less Pi ' Other (explain) �
V. Dispersal/Treatment Area Infor'ntation: C r e- + & v
Design Flow (gpd) Design Soil Application Rate(gpdsf) 1 Ulsparsal a R wired (st) , Dispersal, Area Pro System El t
094 9z •1) ' q2-
j VI. Tank Into Capacity in Total Number Manufacturer Prefab— S e Steel Fiber 1 lactic
Gallons Gallons of [;nit I Concrete Cons Glass �
i New
Was I
Tank& Tanks 1
Septic or Holding Tank __ ____.._._
1
Aerobic Treat"W" Unit
Dosing Chamber
J 1,
� eY
VI ResMibility Statement- 1, the undersigned, assume responsibility ringallation of the POWTS shown on the attached Plans.
Plumber's Na the (Print) Plumber's Si gnature V MP MPRS Number I Business Phone Number
Plumber's Addre is (Street, City, State, Zip Code)
D
VIII. Count /De tment Use O nly
;,Approved 13 Disapproved Sanitary Permit Fee {includes Grouadwator Date Issued Issu ng Agent Sigh re (No Stamps)
Surcitarge Feo} r � �
Cl 0 en Reason far Denial �_ 2 — �T /2(o
IX. Ctinditiolu pproval/ 11or Riffimprosal ,
SYSTEM OWNER: �� L
1 Septic tank, effluent filter and � `` �� h �� �
dispersal cell must all be serviced / maintained
as per management plan provided by plumber, tA--
2. Al l setback requirements must be maintained as per applicable code /ordinances `f v ` `
S k 6+ .
Attaap et[ntplete plea& (to the County only) for the syatsm on paper not less than S14 x It iachea la sift
SBD -6398 (R• 01/03)
.S� ��5���� ��U�i� D��•�t�� /�� `� ✓`G�B �S it /�G.t� y���DSti�� .
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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 81/2 x 11 inches in size. Plan must ro I
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.
Please print all i ation. Reviewed by Date
Personal information you provide may be used for �' s 1 04 (1) (m)).
Property Owner P rty Location
eS Ht U 6/ G Lot S� 1/45 1/4 S23 T 36 N R 2� E (or W
Property Owner's Mailing Addmis L # Block # Sutxi. Name or CSM#
Ir
City State Zip Code —_ _ „ City ❑ Village In Town rest Road
$2 (( I) -2 5t - h w 35
(� New Construction Use: Residential / Number of bedrooms 3 - G/ Code derived design flow rate Y 0 0 GPD
❑ Replacement / ❑ Public or commercial - Describe:
Parent material Q' fC'.3 S t Flood Plain elevation if applicable Ztj 1 g•
General comments 5y,5,/e p-h el-eV
and recommendations:
lo 4ym Aoaj - - t
❑ Boring &L
Boring # 1 �
❑ pit Ground surface elev. _ � C�(� ft. Depth to limiting factor 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 *01#2
I O -(p ( 313 S i 2rr l v 1 .5 • S
2 (� -bo
Si 2m r�nrrr c — -
3 I 1D yN
ca5 b rye 7 I Z
Z I Boring # ❑ Boring (�
_=jj [� Pit Ground surface elev. g l) ft. Depth to limiting facto in. S Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
2 l I P9 lD
2 I Z►,n5b fn�-r c5 . 5 ' $
3
4 lb ti/to
� o
93• � a;�
• Effluent #1 = BOD > 30 _ mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mglL and TSS < 30 mg/L
CST Name (Please Print) i nature CST Number
25 3 g
Address Date Evaluation Conducted Telephone Number
5 25 ��-��� �z C�I5)Zg7--'-1oa8
Property Owner n-�' l Parcel ID # Page � of
F31 - 0 Boris
Boring #• ❑ g
'; : ® Pit Ground surface elev. R Depth to limiting factor in.
Horizon Depth Dominant Color Redox Description Texture Stnrchrre Consistence Bou Soil Application Ra
ndary Roots GPD/ft'
In. Munsell Qu. Sz. ConL Color _
r.•• � Gr. SZ Sh. 'Eff#1 •Effl12
- 9 f v Vr sr 2r,, i � C_
y Icy cod o 59 1
qZ.o�
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 /W
In. Munsell Ou. 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 Ralf
Horizon Depth Dominant Color Redox Description Texture . Structure Consistence Boundary Roots GPD /ht
in. Munsefl Ou. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eft #2
Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/1 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 TIT 608- 264 -8777.
seo.1330 tRO7rooi
PAGE_j>_OF 3
NAME a� ria� G LOT# LEGAL DESCRIPTION SUJ YSr t o ,S ZS T 50 N R ZO .(or)Ql
SCALE: I"= yy
BM 1 ELEVATION IGY>• y
BM 1 DESCRIPTION
BM 2 ELEVATION `q 50
BM 2 DESCRIPTIO -- - -- -
1
SYSTEM ELEVATION 9 3, Q
SYSTEM TYPE �G�j��✓�}�,ti.o — —� —
CONTOUR ELEVATION q':I.SC> Sd, Tf,S - y
c�
r �
�a
Sy e ,,,, � � � 6•
SIGNATURE •�� DATE
i
uyt, v i
SEPTIC TANK PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS
4" Cl VENT PIPE 12" MIN. ABOVE GRADE WEATHERPRO
? 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED
FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER
W/ PADLOCK 6
FINISHED GRADE 4" CI RISER WARNING LABEL
' �'
4' MIN.
1
18" .IN. 6" MAX.
;1
i
INLET i GAS - i
� +
WATER TIGHT SEALS � , • � l
TIGHT i /APPROVED
s
i
A SEAL � JOINTS WITH
iPPROVED -j— ' ALM APPROVED PIPE
1 1PE 3' B 111 3' ONTO
1N70 SOLID C ON SOLID SOIL
'OIL* RISER EXIT
PUMP OFF ELEV . FT. ---- OFF
D PERMITTED ONLY
IF TANK
MANUFACTURER
HAS APPROVAL
3" APPROVED BEDDING UNDER TANK
CONCRETE PAD
SPECIFICATIONS
SEPTIC / DOSE
TANK MANUFACTURER: �.'e��k NUMBER DOSES PER DAY:
TANK SIZES SEPTIC GAL. DOSE VOLUME INCLUDING
�! DOSE GAL. FLOWBACK: GAL.
ALARM MANUFACTURER: CAPACITIES: A = INCHES SAL.
MODEL NUMBER:
SWITCH TYPE: �,�� B = 2 INCHES = 7� GAL.
PUMP MANUFACTURER: u / C = f INCHES = 2 /3, a GAL.
MODEL NUMBER: D = � INCHES = i(�!?...� GAL.
SWITCH TYPE
REQUIRED DISCHARGE RATE 3d GPM PUMP & ALARM WIRING AS PER ILHR 16.23 WAC
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE Z FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . FEET
+ �� FEET FORCEMAIN X ,_f7 - r T /100 FT. FRICTION FACTOR � �2 FEET
TOTAL DYNAMIC HEAD - /.?- 9� _ FEET
INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH DIAMETER ;Z3,-
LIQUID Er= Q' r
SIGNED: 's, ICENSE NUMBER: DATE:
1/88
WEGERER KIL TESTING PAS N
GouidS -, o¢
a E'ubmerslble -�
�- Effluent Pump
La
�f 387 EPO4
1 EP05
Ap'PUCAMU • Ftsbnen; 300 sertes • Fu
o. d" X0
lar the sleet. in to ■ Molpt M OW�ron
bltowlnp Was' 4►� go fa fa et'tfd�tt fNSI'
Gpabla of win tubrI talon and of ltlent strefgQl, and dttribEdy. '
aytterns ft damspe to hest tww
•Meter tw Thermopw.
Moor. Arsik * far WOVAtle and #a wow uww
sump ' EPl)4Si� p �l a wwn. AaC flQ �0 ow llUffdt attach
Wa*tnanafar 116 art f V, QO L 5b0 Modals tMMii1 M pow
DeWal�frtp Rt'�M, Ouilt in mrlaad ofth Moat S aw ■ fftvf Cabo: Sant ,
c reset, Ion" 11 vie faatsry, fated of and w W A61liMt.
_ • EP06 Sin to ohm: Q.S NP, not ,
� ". ON I" V. 0 HL 1550 RPM, FAATVAU AM and tower sopog bulk in ovarto d wtth �Y Merino
boa ct reset t �aitar Nrma- OWNWsm
11 a: u to 56 t3PM. • d:10 9 SJ7 pAO "k"" *
.1
t ow heads: up to 24 anal, wlpt three prpn0 grounding probes".
1l6ERCY tJtTlMfi
ate,. lit? NPt. g 0 ftft �
• SMl: CA4w- Dlug. Optiartat 20 toot ■ El'00 h�eiNr. Thm.
ia+*h 1 tip 5JTW with Dltadc Ntolplsd d1s4n for
BU�NA -4 6 " p� 2mundfng plug lmpto d of IN In r�AC - j u ero
• t fro: (fib M EPap. ■ � d kW R
14&F (�'�:} Nqe ntrous the do * t
• nt Mtn" par mrrwm Mft=-
MW
• 9 b Nn to sal l I g
a�dmumn0 oapablttty: as
cosca up in 54 GPM.
TOW howL. ev10 teat s l
M 114' NPT,
34 slMk OatbOr�• E
stm=rtr on", 4 - t a i
Ti
ra:
� 3 to f
��efit. a
� f ,
e Q� • 0
d
1� p .i plane• +. CAP"" 1e 1a AMYU
ui�k4�
STANDARD CHAMBER
Quick4 Standard Chamber 48• -
(EFFECTIVE LENGTH)
`� n
F-� e
34' SIDE VIEW
SECTION VIEW
MultiPort End Cap
r
12"
34" —
SIDE VIEW TOP VIEW
FRONT VIEW
116 16 ✓ 0111111
e
pi Jut ON
*411
n §P
r< Quick4
Sta ndard m 5 FuNi
Mw tipi
�34 52 x _: . Size (Wk
—iI
Size(WXLXH)n—�—` 12" x 16 "X 12
Effective Length 48" Invert Height 8` or 1.25"
intlil Height 811
INFILTR A�TQA SYSTEMS INC STgryp�RD MITEQ WA8FJANTy
Ica Ire str-hrra! rileg"Ilyt Of each Chai , end plate. wed9c. and Other acre o. rlu ;I tll UY I- 111111 alo , ll ry I wi nstalirf and operated
cat:bfil of an ol siritic system in accordance it warranted to V!0 Ong-1 Plitirtlaw i'll ar?atl dell
and 1volkw"SInn tor "Ile year foin tire. data thal lie Sopir MIT.1 I, 'sued too the spolin aysian rontal the Units, provided how -
na a Sept r: mrri r; not
"BlIalull by aMilloal law, the warranty panel wit l begin tipor, the date I" installation oi the septic sy iern COMIT-enolas
To Pxrirct l Aarrjrr rl H oller "'list ril Infiltrator 1- miriv at 's orporate Hoad'Itianel In Old Saybrook, Co-wfiwt mthn fr`171 115)
=hil a grit iii,w
ino, w1l su pp l y F erildoernent U - ti wil units det l)y inti by all 10 be C"ed all b"IFMI wavanty
pair Il FACArdea the col of removal al mall ot the jars, Rk Ing 14 1. Q
O
�Lr I LIMI 7FCJ WAWANrl AND REMII hN SWPARINGFIAPH tal.ARF E.X(4 A l[ No OTHER WAWANTIF!3 WIT
HF, UNITS ""C; ODW NO IMPLIED WAIiRANl IES 0 ' WRCHAN T ABILF'r _ R I'l rrlil,.�33 FOE PARTICULAR PURPOSE.
- I C tjSIVJ� 71 CJE , H RFSP SYSTEMS INC 0
� [.-il W,, h_11 be A
-r - �-Iy pad Jr� l ,hl tha
rot n one,
I h,, to . .1
1 1- dta
-1 conol� spacial "' " ild " l oa— for PP. ,all is r u
-d l Il al rra�,lei -elbitiol o, Wz "`I Gril nil! bili WA x � 0 Ill da
01 '—�' 01 i�Penl 1 by pee Holder or al third party, _cpMjIll EntlilmnMentAf Onsits Westew4jtw.-vjuaow-
—te, are daniags to ll 'D 0 ' dr na t y —e and f ear, *6 8=11val rntsuse, ate or
L`l
Ule
Units; the Ul il 1 - 0 1 01 I to �lah l. trafli or olt Mich are not 00IM-1100 by trill installation instructlons: failure In r lapnlain the n +nllnum ground C.-S, sal t form 4 the
InGlallelionpl f .on 6 Business Park Road • RO, Box 768
int- ijnits Cr the San System clue on e; the Oacer'M Qf IMPffl Materials into t" System containing 11w, Un,I-y failure of
to in` 0 Sil 9, aK
im I �1 icelssitle, vyl rsage in roory grease d
al l shall void the 1-10.1,'f3r tails to ct
any other event not cal by 1,forralo', This limited SPOGRI, Dr nproper qlerajon; or
W."arty Orl with III Ot the fern Is Sol forh in hi Lill Old Saybrook, CT 06475
in no event stipi ; a ible - - to apply the Units mul be Installed in actcordance 860-577-7000 - FAX 860-577-7001
- by Slate and iol codes; 80 01", JipplcabJeta� are Infifil"itor
rile condilrons rOquirGe
or from any Po 1,8.
"'In pa,,, F or 1", Hander, 11 "' C) l OF airy thrd Parry resulIncl from irriSlaSanon or ship 800-221-4436
ldi No repnGenlatrva p. I I II arHlor ta. Ill
Ila, Foll
&he H.1414
-1-. ri (jrd Saybrook, C- prior to S..h 10 oblaii� a
c PV 0 % warranty, an d shol carefully teat warranty prior 11 rho - -chase of Units.
ti S. Patents: 4, 5,017,04 5,156,488; 5.336.017 ' 5,401, I b; 5,401,459; 5,511,903; 5,716,163; 5,588,778; 5,839.844
Canadian Patents: 1 . 329 ,959; 2,004,564 Other patents Pand'ing,
is In filtrator, Equalizer and SideWillder are registered trademarks of Infirraitur Systems In infiltrator is a registered trademark in France, Infiltrator System Inc.
a felstened trademark in Mal c)Ontoor Centel- Swivel Con nection, MK;�Galcnirtg, PolyTtiff, SnapLock, ChamberSpaosr, Posil Que ay
and Ol ere trademarks of Infiltrator System Inc, t9 200E Infiltrator Systems Inc. Printed In L) S A kIFt RICYCL80PAPER
POWYS OWNER'S MANUAL & MANAGEMENT PLAN Page of
.JN I SYSTEM SPECIFICATIONS
Ow ,er S�jo G 00b 90-V Septic Tank Capacity �',S a l Q NA
Permit +t - -
�j Septic Tank Manufacturer 0 NA
DESIGN PARAMETERS Effluent Filter Manufacturer f 0 NA
Number of Bedrooms 0 NA Effluent filter Model ,� 13 NA
Number of Public Facility Units 0 NA Pump Tank Capacity �j�' a l 10 NA
Estimated flow (average) 2vo a l /da pump Tank Manufacturer S 13 NA
Design flow {peek), (Estimated x 1,5) � gal /day Pump Manufacturer 0 NA
Soil Application Rate d - _ gal /day /It Pump Model 0 NA
Standard influent/Effluent Quality Monthly average' Pretreatment Unit 0 NA
Fats, Oil A Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter Q Peat Filter
Biochemical Oxygen Demand (600.) 5220 mg /L Q NA Q Mechanical Aeration D Wetland
Total Suspended Solids 1TSS) x150 m /L ❑ Disinfection D Other:
Pretreated Effluent Quality Monthly average Dispersal Coals) ❑ NA
Biochemical Oxygen Demand (600 S30 mg /L O in- Ground (gravity) O In- Ground (pressurized)
Total Suspended Solids (TSS) s30 mg /L ❑ NA O At -Grade 0 Mound
Fecal Coliform (geometric mean) 510 cfu /1 00m1 ❑ Drip -Line ❑ Other:
Maximum Effluent Particle Size Y in die. ❑ NA Other: 0 NA
Other: n NA Other: ❑ NA
* Values typical for domestic wastewater and septic tank effluent. Other' -� ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Fancy
Inspect condition of tank(s) At least once every: al (Maxbeum 3 years( ❑ NA
_ ear(s)
Pump out contents of tank(sl r When combined aludge and scum equals one -third %) of tank volume 0 NA
Inspect dispersal cell(s) _ At least once every: 3 meads) s) (Maximum 3 Veers) ❑ NA
Clean effluent filter At least once every: Q. me � (a) 0 NA
X yews)
�_
inspect pump, pump controls S alarm At least once every: :---- O moftth(s) a ears! O NA
Flush laterals and pressure test r. _r At least once every: 0 month {al O NA
d (s)
Other. - month(*) C3 �- -.�
At leas[ once every: p yserls) DNA
13 NA
MAINTENANCE INSTRUCTIONS
Inspection* 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 Inapactor, POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tankis) 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 cells) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface, The ponding of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one - third %) or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin 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 s12 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
inting products or Other OhOM40.1a
START UP AND OPERATION seance of pa have the contents
to use of the pOWTS check {reatrntx+t tank(s) for t# hi con centrafrone are detected
construction, prior teal ceillsf
n o w e
For a or damag the disp
e the treatment p and/ eg
that may lmped
of the tank(s) removed by a septsge servicin g operator p rior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highweter levels. When power is restored the excess wastewater will be
in the backup of surface discharged to the
dispersal ceH(s) in one large dose, overload mp tank removed by a 800696 Servicing Opera oP ror restoring
effluent. To avoid this situation have the contents o P
power to the effluent pump Of contact a Plumber or POINTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersa cells. Do not drive or park over, or otherwise disturb or compact, the area
within IS feet clown slope of any mound or at -grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides: meat scraps; medications; coil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and /of is permanently taken out of service the fallowing steps shall be taken to insure that the system is
pr ! and safe) abandoned in comp liance with chapter Comm 83.33, Wisconsin Administrative Code:
Y p
• th abandoned pipe openings Ail pi ping to tanks and its shall be disconnected and e s sealed. p P P 9
PP g P
s The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
e After pumping all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
i3 A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing . and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
17 A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS
technology ho) k m inst a l led a last resort to re place the failed POWTS.
gy ding tan may 4e at ed as p
� T
d site
$A tank
D Mound and at -grade soil absorption systems may be reconstructed In place following removal of the biomat at the
. infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAIN
ER
Name Name
Phone 7 / _ �. -- �P • Z Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name w Name r (�
Phone
Phone S 3� .
This document was dratted in compiiance with chapter Comm 83 .2212)1b1(1)(d16lfl and 83.54(1). !21 & 131, Wisconsin Administrative Code.
SFPTIC TANK MAIN'TINANCH AGPBPIIUFNT
AND
0 "I"'N'F P SHIP C EP IFICA110N FORM
C)"" ter, !Buyet St. Jo
h 2 fQr_pQXAt
__-
Mailing Address 12415 55th Street North, Lake Elmo, MN 55042
Pruperty Address
(V= requirM from Planning Department for new Co='.-Ucti0n)
Ci
Town of St.Joseph,Wl
Pared Ider.Cficadion Plumber See Attachod-keP-d—
LEGAL DESCRIMON
Property Location --j._W SOC. ToAm of St. jg5e2L-
Subdivision Settler's Glen
Lot #
CcrtMed Survey Map 4 V01=e Page #
Wanwtty Deed # 700569 Volume —2-0(v!- Page #__
Spec house 0 yes K no Lot Imes identifiable N yes C1 no
fimm
IUMMperuse and =tiaLenanoeof your septic rjmteMcued =sm:' in iftpremawmf4ure to h=dIew&ftes- Proper =iiU=az=
cOASiSU Of MOM Out the WPdC tank every tb=c yem or swat. if needed by a Ej p %" you p into the c
at Iffba 6d ruaction of dig septic Wk as a 1tratmeni CtW in the cute d*xal systam
MW pr MCM cvz= 99reft to Mbmft to SL Cmix Zming Depart I cer form, siz=d 6y the OWC= said by a
mast a ph=bar.jo=eyn re6tzictedpb=Leror a Uctzsed pu=p crverifying d (1) t h e on wz sp
is in proper opemdM cotdition and/or (2) after k L q x)c d ft and PUm;Yir4 Cirvecenny), the septic twk is ICU than 1/3 full of sludze.
VW06 the uncle rsWood have road the above rcquixt=cuts and agme to maint 11 private sewage dispasaj sysum with the stazduds
set brtk hat4 as W by dw Demutum of Co mmem a m the Dqmtm=t R= S o r Wisconsin.. C= Acttior-
rating dw y our UPfic 6 yU= has b= m be wimpteted and retamed to th St. 4oi County Zoaing Off within 30
days of the pe Year te. expiation P-01*
DATE
03YM rF,1k7T=d-AI-V^V.T
I (we) CCtLfY this au t Ott this fOm W. tee to the be-I of my (out) knowledge. (we) am (L 0 4: � S ) o f
t4 '- PrOPatY d*!5A above, by v*ifthe o f IL wxMQtY deed recor&A i ;Lee 't 6C Wn
SI;WRATME MOFAPPL — AI ' e ll
DATE
••••*• Any information that is Mis-nPruented=y result in the SI:dWY Pemlit being revoked by d Zoning DerpartMcnt
Include witb this appli a stamped wl(ranty dec r
mm the Register of L)cedscffi
a copy of ehe cerfifed vxvey reap if mf frrnce is made in the wirnmy deed
J 2 0 6 5 P 5 `l 8 - 7 00569
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 01:00PM
Henry J. Lentz, for a valuable consideration conveys without warranty to EXEMPT t#
ST. JOSEPH DEVELOPMENT CORPORATION, a Minnesota
corporation, Grantee, the following described real estate in St. Croix REC FEE: 13.00
County, State of Wisconsin: TRANS FEE: 4590.60
COPY FEE:
CERT COPY FEE:
PAGES: 2
See attached addendum.
This is homestead property Recording Area
Name and Return Address
LAND TITLE,
y 1900 E:!- (OAD
ME'.! Efii:a"rc.:., t: N 5511
I" NO, I I '7 G /
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 thi day of 2002.
'Henry J. L Trust
`
*Bernice A. Lentz
AUTHENTICATION
/
Si ACKNOWLEDGMENT
gnatures) J. � , r` L2 Q rw�
-�� STATE OF WISCONSIN
l"5c t` n Y g A, LQ V1 � ST. CROIX COUNTY
.
yy Personally came before me this _ day of
authen ' ted t is day of �V �� • 2002, the above named Henry J. Lentz, as Trustee of the
n n Henry J. Lentz Family Revocable Trust, and Bernice A.
pX X Lentz, to me known to be the person(s) who executed the
signature / foregoing instrument and acknowledge the same.
13 C:' -V7 r_
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 edStJosephOevetopment -02
1 2065T .549
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 SW I/4, PART OF THE NEIA OF
THE S W 1 /4, PART OF THE SE 1 /4 OF THE S W 1 /4, PART OF THE N W I A OF THE SE 1 /4, AND THE
SW I/4 OF THE SEI /4 ALL IN SECTION 23, AND IN PART OF THE NEIA OF THE NWIA OF
SECTION 26, ALL IN T30N, R20W, TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN;
DESCRIBED AS FOLLOWS:
BEGINNING AT THE SOUTH QUARTER CORNER OF SAID SECTION 23, THENCE S89 0 59'28 "E
ALONG THE SOUTH LINE OF THE SE 1/4 OF SAID SECTION 23, 1329.95 FEET TO THE EAST LINE
OF SAID SW 1/4 OF THE SEI /4; THENCE N00 °05'53 "W, ALONG LAST SAID EAST LINE AND THE
EAST LINE OF THE NW 1/4 OF THE SEI /4, 2662.66 FEET TO THE EAST -WEST QUARTER LINE OF
SAID SECTION 23; THENCE S89 0 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 °]5'03 "W A DISTANCE OF 100.00 FEET TO
THE SOUTHWEST CORNER OF SAID LOT 2; THENCE ALONG THE SOUTH LINE OF CERTIFIED
SURVEY MAP RECORDED IN VOLUME 4 PAGE 944 S89 0 44 1 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 °5749 "W, ALONG
SAID EAST -WEST QUARTER LINE, 1107.54 FEET; THENCE S00° ] 7'14 "E A DISTANCE OF 304.14
FEET; THENCE N89'4 1'28"W A DISTANCE OF 404.95 FEET; THENCE S00° 17 14 "E A DISTANCE
OF 1025.47 FEET TO THE NORTH LINE OF THAT PARCEL DESCRIBED ON DEED RECORDED IN
VOLUME 562, PAGE 563; THENCE N89 OS 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 1 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° I5'40 "W, ALONG LAST SAID WEST LINE, AND THE
WEST LINE OF LOT 1 OF CERTIFIED SURVEY MAP RECORDED 11-4 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 l; 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.
L.B.O. =905.0
\ \ H -�VL. =903.0 /
LOT 18 \ \ \ J
3.002 ACRES
30,759 SO. FT. r \\ \ \
DRAINAGE \ LOT 13
EASEMENT I
3 �
�� \ .000 ACRES
/ a \ \ �%. 130,682 SO. FT.
1�
/ \
L. =905.0 '
/ H•W.L. =903.0
LOT 17 \
3.001 ACRES \ \
/ 130,722 SO. FT. \ :
N CO
\ �N89°5 7 82.41
LOT 16 �`
\ \ ?!;k 3.000 ACRES �' /\ ' 89 7'W 82.4E
130,992 SO. ` .
/SEE DETAIL
`� ' �`$� • c�P
ON SHEET 4
s
SHEET 3 OF 5