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HomeMy WebLinkAbout030-2131-17-000 Wisconsin DeparmentofCommerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Bui�rig Divi*ion INSPECTION REPORT Sanitary Permit No: 453361 0 GENSWL INFORMATION (ATTACH TO PERMIT) " State Plan ID No: i Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: St Joseph Dev Corp St. Joseph Township 030 - 2131 -17 -000 CST BM Elev: Insp. BM Elev: ll i escription: Section/Town /Range /Map No: 23.30.20.1071 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding SVHt Inlet TANK SETBACK INFORMATION St/Ht Outlet y 4 yv TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \ Septic� y 3 00 Dt Bottom Dosing Header /Man. ( 7 n o c ,� •�► 6 b S Y Aeration Dist. Pipe el r� Holding Bot. System 5 i t. t Elli 8 Final Grade PUMP /SIPHON INFORMATION �/ q Manufacturer _, Demand St Corer GPM a O •� /Gw•/ Model Numb ` TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. , to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS � R� - 11 1 8 ,' 1 SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer.. INFORMATION CHAMBER OR � Type Of System: �(.> UNIT 11 d ci V a�✓�'� c:- h C 7 �^— 7 �j /'� Model Number. rl DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake to Pipe(s) - - -- Length c 1j t Dia Length Dia Spacing L F 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 A Bed/Trench Edges Topsoil Yes No Yes j' j No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 10 i f`t / c-�'• Inspection #2: / / .cn• w I Location: 153 Heritage Trail Unknown (N 1/4 SW 1/4 23 T30N R20W) Settler's Glen Lot 17 Parcel No: 23.30.20.1071 1.) Alt BM Description 2.) Bldg sewer length - amount of cover Plan 10 (R.3/97) an revision Required? ! Yes = No Use other side for additional inform ion Date �_n?epctoes Signature Cart. No. I Safety and Buildings Division � County ttr ,� 201 W. Washington Ave., P.O. Box 7162 f ' iscoinsln s' tea , in Madison, WI 53707 62 Sanitary Permit N mber (to be filled in by Co.) Department of Commerce (608) 266 -31 3 3 tPr Sanitary Permit Application .D. Nu mber In accord with Comm 83.21, Wis. Adm. Cade, personal info o rovid may be used for secondary purposes Privacy I ( ®Cr _I nPrQject A ress (if different than mailing address) I. Application Information - Please Print All u`J4t c0 , y / �f c-�z Z4NJ 53 IVO OPFI Property Owner's Na me e] Lot >Y Block k --- I Property Owner's M ailing Address Proper Location Y /.S - I C ity, State Zip Code Phone Number �� ''A. J5 / !4,Section _ L' C[ e �G 4 fj?/J/ S �Q X102 (circle o y�J f II. Type of Building (check all that apply) T � N: R 96 E or dyJ or 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Number ❑ Public /Commercial - Describe Use Se- z ❑ State Owned - Describe Use —: ❑City ':DVillagejTownship o '_ , III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System 11 Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Rene al c Permit Revision ❑ Changi � of -❑ Permit Transfer to Ne List Previous Permit Number and Date Issued Before Expirati Plumber Owner k IV. T of POWTS S stem: (Check all that a 1) 31 �'Y oZ on -- Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland El In Ground ❑ Holding Tank L1 Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter eaching Chamber ❑ Drip Line 11 Gravel-less Pipe El Other (explain) V. Dispersal/Treatment Area InPorrnation: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Pro System Elevation VI. Tank Info Capacity in Total Number Manufacturer Pr Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing i Tanks Tanks Septic or Holding Tank I - Aerobic Treatment Unit Dosing Chamber - - i VII. Responsibility Statement- 1, th4 undersigned, assume responsibility for Installation of the POWTS shown on th attached plans. Plumber's Na me (Print) Plumber's Si gnature / RS Number Business Phone Number Plumber's Addre ss (Street, City, State, Zip Code) 7 QQ -� 7 l -�— 3� � VIII. CotmtylDe artment Use Only — ' A r Sanitary Permit Fee pp owed ❑Disapproved S Y ( Groundwater Date Issued I wing gent Signat (No Stamps) .s Surcharge Fee) ❑ Owner Given Reason for Denia! I X. Cond 1 Iitions of Approval /Reasons for Disapproval 3 ) t , r I t SYSTEM OWNER: 'V 1 Septic tank, effluent filter and tyyvl S 2 - dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. q) _ 7E 4 c -- 5 Attach complete plans (to the County only) for the system on paper >;ot le than 81/2 x I I i is size , SBD -6398 (R. 01/03) 4 b � i v U r� C Y om^ .�yyQyS. �s Or- 4. A( w ,f�a `r�� ,Oo ef rr sv l/ \ /e4 ° S sT�N �/ a c 41 .b ws� r e A Q om, c4 � s , o •p j �3 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County � • � `� � Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. a 'wed by Date Personal infomiaGon you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). O � � i 3 Property Owner Property Location ' J Ca +(- mod, _ Govt. lot 4 �Z X1 /4 1/4 S T &O N R ojQ E (or) Property Owner's Mailing A ress Lot # I Block # I Subd. Name or CSM# 1V v l ? -<,-- (s-C City State Zip Code Phone Number ❑ city ❑ Village ® Town Nearest Road New Construction Use: ® Residential /Number of bedrooms 3-'Y Code derived design flow rate `«��o �o GPD ❑ Replacement ❑ p Public or commercial - Describe: "T Parent material U U U Tc� S V, Flood Plain elevation if applicable General comments b and recommendations: S`/S�` ''" e 1 e J . r- F Boring # E] Boring rI ® Pit Ground surface elev. f 6 • Z 0 ft. Depth to limiting factor /3 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. 1 •Eff#2 wt lk f s l irk ( -1 3 Zt �g # Boring Z pit Ground surface eiev. F6 • Zd ft. Depth to limiting factor 3 U in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. / ff#1 •Eff#2 Z lip 5 /o. � � — S,` Z»�s k v►'` {� � S — . � . G 5y -7 1 u,/ , 11 — a s 6s < 7y -13 I0 / o — S Use v✓ 2.- Effluent #1 = BOD > 30 < 220 mg& and TSS >30 1 150 mg& ' Effluent #2 = BOD 1 30 mglL and TSS < 30 mg/L CS Name (Please ) re CST Number i w yno, 61r Z - 63 -30 Address Date Evaluation Conducted Telephone Number fi� v Property Owner Parcel ID # Page of Boring # 0 Boring ® Pit Ground surface elev5� d ft. Depth to limiting factor �, in. Soil — Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 1 •Eff#2 3 7 5 , v7ry/ — os YV1 C,5 C .5 1/h F-1 Boring # E3 Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPDM In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 I •Eff#2 Boring # C] Boring 11 Pit Ground surface slay. ft. Depth to limiting factor F in. Sal Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Effluent #1 = BOD, > 30 <_ 220 mg/L and TSS >30 1150 mgA- • Effluent #2 = BOD, 130 mg& and TSS 130 mgrL 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. L r I'Ma, 30r 3 �9 S NAM>r:� i�_�I.OI'1l� 7__I.IiC;AI. I)1,SCR11' "l�li)P1:�6 1tpW /9 G � I'= U ,/SCALE. --- - -_ - -- -- g„� I ELLVATION:__�U BM I BM 2 r.LGVA'l 11d: - - - _ — - -- - BM 2 DI:SCRIP HOI I: -- - -- SYSTE-N1 LI,I,VA "1'1( )iL �t> v SIGNATURI �l d �v FT. •• .• 1 • • • &002ACFES \ O • t , ,• •� •, � . ` H.V�[ =963.0 r : ••. •• r �,,. • DRA ••, .` ` EABBM to 6 O LOT 1 s o `• Ili � •, `• • ••• _ • • i� :w • • ♦ •` , • 8. S. h : -. • • • • �, • •• ••� • S o .• •• •• • • • is LOT is is ••• ••• 1 411� MW ACFM •• ` . r • •. ,,� III ACTING •., •., •. r �r+ THE .� 1 NO LWAM �F'FaCTtMG •. t '•. • . . S i g w,ti Safety and Buildings Division County 1 201 W. Washington Ave., P.O. Box 7162 � VlsconSi�i1'1 j Madison, Wl 53707 - 7162 Sanitary Permit Number (to be filled to by Co,) Department of Commerce I (608) 266.3151 3 3 ( l j Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code. personal information you provide may be used for secondary purposes Privacy Law, s15.04(1)(m) Project Address (if different than madmi; address) 1. Application Information - Please Print All Inform ion RECEIVE17 - 15 3 L Property Owner's Na me Parcel # rlt Block # S7 v e. ; " h .Al GD y Property Owner's 94 ailing Address o � Property anon , 1.2 1-113 - - S�� _5 v e t•rae) � � 0 _.�1 .0 u sCJ �� ,Section s ,23 City, State Zip Code / Phone Number �Df1� x/11 D J �(� (Circle One) T -Fe N; R O E otg I1. Type of Building (check that apply) as S 1 or 2 Family Dwelling - Number odroorns Subdivision Name CSM Number ❑ Public /Commercial - Describe Use ❑ State Owned - Describe Use ( City ovillage,Q of III. Type of Permit: (Check only one box X11n e A, Complete line B if appl' e) 0 30 _ 2131' jpw A. )k New System ❑ Replacement System ❑ Treaanent/Holding Tank placement Only ❑ Other Modification to Existing Syste B. ❑ Permit Renewal ❑ Permit Revision hinge of ermit Transfer to Now List Previous Permit Number and Date Issued Before Expiration 1 Plu r wner IV. Type o POM stem: {Check all that a 1 } ! KNon - Preuurixed W- Ground ❑ Mound > 24 in, of suitable s Mound < 24 ; su' a U At-Or* 11 Sit 0 Pas r ❑ Coratructed Watland Pressurized In- Ground ❑ Holding ❑ Peat Filte ❑ t rea•,rnent Unit ❑ R ter j Raoirculatia S ntlwtic Media Filter caching Chamber ❑ D Line 11 G Pte Other (explain) V. Dispersal/Treatment Area Information: Des' Flow (gpd} Design Soil Application ( » Dispersal Area quired (sf) tspersat Area Ptapwed (sf) Syst Elev n 0 • 2 S • _ f I �.o j 1 VI. Tank Info I Capacity in V Total jRurnber Ma acturer fa Plastic i Gallons Gallo of Units re natructed I New F.xud Gallons ng ranks Tanks Septic or Holding Tank ! 1, I d 1 Aerobic Treaunaru Unit i i Daft Cltamher VII. $espondibility Statement- I, tit erslg»ed, assume responsibility for ailation of the WTS shown on the attached S. Plumber's Na me (Print) lumber's Si gnatur � MVNIPRS Number Business Phone Number ,c l� c� k yv►�y ,�,�,9 Plumber's Addre is (Street, City, Stf7Zip Code) Ze 74` VIII, Count /De artment Use jWy Approvgd ❑ Dui ov Sanitary Permit Fee (i Ludes Graundwaror Date Issu 'ssu'n Agent Signatur (Na Stamps) Surcharge Fee) 0 r Given on for Denial 2 Q j IIX. Conditions of Approval /Reasons for Disapproval 3) No . tvr,�yxpvev�e,,, . eA SYSTEM OWNER: �''` 1 Septic tank, effluent filter and RODRR�VhG.�,'� p , dispersal cell must all be serviced / maintained d J as per management plan provided by plumber. �f(,� �►sNpV� - '0 2. All setback requirements must be maintained I as per applicable code /ordinances, f i AtS VW- AttaClt roraplale platy (W the Connty only) for the systaes on paper not Leo than 31/2 x It iochea in sine S13D -639R IR 01 /(1'i1 r r i; TA �. i ^ r i ,. Vc 4 4 u: `r i p 1. e .y ��e e t rl,� ,e �'.� y gy ON c S r W 6� �3 c t-1 ,�n�A a 77, " , z� 4 ot, low a r 4 Ld i� P 1 4k o �� Te ��3 ,v �, « `,,.. r s j�_ .x) �6 1' ,� � , �. . �-� �'w \'• W�., 7M i I Wisconsin Department of Commerce SOIL EVALUATION REPORT Page �of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 12 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. l percent slope, scale or dimensions. north arrow. and I disfam to nearest road. eviewed b Date Please print all info tior. i -y.� 1 _ Personal information you provide may be used for seconds purposes (Privacy Law. s. 15.04 (1) ))• L 2'l Property Owner r rty L on C Urr 1G e S Govt. Lot Sw 1/4 SL 1/4 S Z3 T N R Z (-) E (or &,) Property Owners Mailing Add s i — -� -- -- Lpt # lock # Subd. Name or CSM# / City State z Code Phone Number ❑ City ❑ Village .Town Nearest Road I MN 2 c 5l ) y3°I -2L4 ® New Construction Use: Residential / Number of bedrooms _ 3 Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: U A 1 e St _ Flood Plain elevation if applicable Parent material 6 ft General comments 1 S4.Q WA t [ (/ �S and recommendations: r� ! �• �► y � Boring # ❑ Boring r' 10 Pit Ground surface elev. Gq -OU ft. Depth to fimiting factor I `,� 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 •E02 I - -- 511 ►�-� CS I 5 . 2 - 5 t0 -' 5L 2n k s — _ 5 .9 ❑ Boring # Boring n 4 [� pit Ground surface elev. • '1 0 . (o() ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1 tz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 ©ice 1C) 31 f I vy 5 8 Z I i() ry 4 SL Zm5 m r C5 — 5 . • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 _< 150 mg/L ' Effluent #2 = 8013, : < 30 mg/l- and TSS < 30 mg/L CST Name (Please Print) nature CST Number Schv er Z53309 Address Date Evaluation Conducted Telephone Number 54025 Property Owner Ca( 1 Boring # Parcet ID # • . 2 ` �'� 3 ' ❑ g Page =_L of -Pit Ground surface.elev. q '1 o ft Depth to limiting factor in. Horizon Soil Application R, Depth Dominant Color Redox Description Texture . Struchrre Consistence Boundary Roots GPD/(t2 In. Munsell Qu- SE CbnC Color Ge, Sz Sh. 'Eff #1 ° 'Eff #2 �' U y SL• s � �r c -- , 5 , g F-1 Boring # ❑ Boring ❑ pit ' Ground surface elev. ft. Depth to limiting factor In. Horizon Depth . Dominant Color Redox Description..- Texture Structure oil Application Rai ucture Consistence Boundary Roots GPp /fl= In. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2 F-1 Boring # Boring ❑ El Pit Ground surface elev. t1- Depth to limiting factor In. Soil Application Rat, Horizon Depth Dominant Color Redox Description Texture . Structure Roots GPD /h= e Consistence in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 •Eff #2 ' Effluent #1 = BODs > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD 30 m s < _ gna 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. SBD-1330 (R07100) i PAGE - 5_OF N A M l Q rr -'o aQ- LOT # -�- LEGAL DESCRIPTION S W Y5 F- X ,S Z3 T36 N R 2 E(or) SCALE: I"= /D BM I ELEVATION BM I DESCRIPTION r c- fie BM 2 ELEVATION /66, y BM 2 DESCRIPTION SYSTEM ELEVATION So SYSTEM TYPE Coe\0.4ior CON'T'OUR ELEVATION 00 4- G0 x1 1 �d u II SIGNATURE DATE & r-22 - 0 Z R ' POWTS OWNER'S MANUAL & MANAGEMENT PLAN p age of FILE NVORMATION ESYSTEM SPECIFICATIONS • �'�� e t1 Septic -Tank Capacity Pe rmit � v ,sl t7 NA �G Septic Tank Manufacturer 0 NA DEBIt�N PARAMETIERS Effluent Filter Manufacturer O NA ffNUMber aoms O NA Effluent Filter M odel a NA ic Facility Units Pump Tank Capacity a l 13 NA (average) o af /dav Pump Tank Manufacturer r aNA Design flow (peak), (Estimated x 1.5) �p g al/day Pump Manufacturer G.I�� 13 NA Soil Application Rate al /do /ft' Pump Model (Ct�O 0 NA Standard M #luent/Effkent Quality _y average' Pretreatment Unit A Fats, Oil & Grease (FOG) S30 mg /L Q Sand /Gravel Filter © Peat Filter Biochemical Oxygen Demand 1800.) 5220 mg /L O NA 0 Mechanical Aeration Q Wetland Totai Suspended Solids (TSS) S1 E0 mg /L O Disinfection O Other: Pretreated Effluent Quality Monthly average Dispersal Coif(s) ❑ NA Biochemical Oxygen Demand (SOD.) 530 mg /L �Kln- Ground (gravity# D In Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA O At- tirade d Mound Fecal Conform (psometric mean) 510 afu /100m1 0 Drip -Line D Other: Maximum Effluent Particle Size Ys in dia, 0 NA Other: O NA Other: ❑ NA Other: C NA Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Evem Service Frequency inspect condition of tank(*) At least once every: j s e (Maximum 3 years) t3 NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume © NA Inspect dispersal cells) At least once every: eels) (Madlmum 3 years) E7 NA mo Clean effluent filter At least once every: / O yearth(s) O NA Inspect PUMP, pump controls & aierm At least once every: month sl L] NA C3 year(s) Flush laterals and pressure test At least once every: .— moo (s) 0 NA O earls) Oar O monthial At least once every: C ,) Q NA her Ot: 0 NA MAINTENANCE WSTRUCTIONS inspections of tanks and dispersal cells shall be made by an lndlv'iduaE 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 tanks) 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 cen(s) shall be visually inspected to check the effluent levels in the observation pipes and to chock for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a falling 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 (Y3) or more of the took volume, the entire contents of the tank ohs" 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 f effluent filters mechanical echan)cal or essurixed om onenta p retreatment units, and arty servicing at intervale of 512 months, sha)i be performed by a certified POWTS aintainer p p A Service report shall be provided to the local regulatory authority within 10 days of cwttpletion of any service event. r •ap03 9A13eJ19lulwPV u!su 'I£) 9 (Z) '11)1118 pus uiwoa Jeide4o 4V M► sau111ClWQ0 u! p04 ;sip sum lumnaop w41 0 �4d auo4d . 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(s)llso IesJGdslp 041 01 p9BJO4091P aq Illm Jelenn94sgm sseoxe e4i pe,ols9J si ismod ue4M •sl9A9I JUIBM4 iewJOU OAoge p!; Aew "ut1 dwnd saB03no Jemod Bu1Jno got ;Jns 9A!41J1I!;u1 844 19 u920J; 9Je suo!ilpuoo I!os uogm Jnaoo iou 11 do volt WO)SAS •99n of Jolid Jolvisdo Bu!oiAJes e8eides 0 Aq POAOweJ (s IUM 041 ;0 sweluo0 043 GAR4 P910919P eJe suol4 eJ1u9'-'u 00 ON A ' (s }1100 IesJedsip e4i 089wep Jo/pue sseooJd luewi9aJ3 943 apedw! Ae 1944 sleo!uJe40 J0410 J o 9 Bu!wled ;o om*59JO 041 Jo; (sMuel I ua w ia eJl 13640 SJLMOd e4i ;o 9sn of Jolid 'uoponrlsuoo Mau Joj N011Vl13d0 aRv do iwv.LS to - -_ e8ed . M Y• • SE PTIC TANK E PUMP C HAN. HFR CROSS SE TION AND SPECIF CATION 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 W1 PADLOCK & 4" CI RISER WARNING LABEL ---t -.�..- 4 " M714. 28" IN. 6" MAX. It INLET 1 WATER TIGHT SEALS GAS- , `_ A TIGHT + vAPPROVED SEAL JOINTS W ITH ni APPROVED -i-r ' ,A LM APPROVED PIPE L )NTO SOLID � I SOLID I C ; OIL PUMP OFF ELEV . FT . -+— OFF RISER EXIT D PERMITTED ONLY IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE.PAD SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER: t ,5�� NUMBER DOSES PER DAY: TANK SIZES SEPTIC 1�.,5Q GAL. DOSE VOLUME INCLUDING - DOSE y g W GAL. F LOWBACK : �J GA;. . ALARM MANUFACTURER: L c CAPACITIES: A = M INCHES = C/ GAL. MODEL NUMBER: p t_y SWITCH TYPE: _ r \% %c B = 2 INCHES = �� GAL. PUMP MANUFACTURER : Go C = INCHES = GAL. MODEL NUMBER: Pa SWITCH TYPE: farlLc D - INCHES - a c0 GAL. REQUIRED DISCHARGE RATE ' GPM PUMP & ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE IQ FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . 2.5 FEET + (a FEET F ORCEMAIN X SO FT /100 FT. FRICTION FACTOR . — TA FEET TOTAL DYNAMIC HEAD = 7J�FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH .-,, ; WIDTH •--- DIAMETER LIQUID DEPTH <3B ; ya j &,4L pee SIGNED: �et�- z ap' ®�. ---- LICENSE NUMBER: LATE: 1/88 r - ^ r i [ RGOULD5 PUMPS Submers Effluent Pump Aii 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 bail bearing following uses: lubrication and efficient improved performance. construction, • Effluent systems heat transfer, ■ Casing and Base: Rugged • Homes Available for automatic and thermoplastic design provides AGENCY LISTING • Farms manual operation. Auto- superior strength and corrosion stardaidsAssoc�aon • Heavy sum resistance. vY �`/ P matic models include • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end •p u• "C ewateri n for efficient heat transfer, in F r 9 assembled and reset at the o P stren factory, gth, and durability. SP ECIFICATIONS ■ Motor Cover: Thermoplastic Goulds Pumps is ISO 5001 Registered. FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. I le 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 NPT. seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA -N elastomers, • Temp erature: erature: 1041 (40 continuous 140 1 f (60 intermittent. METERS FEET • Fasteners: 300 series 10 stainless steel, g 30`"" SGT -_ • Capable of running dry without damage to 8 *2 rr components. 25 7 Motor: z • EPO4 Single phase: 0.4 HP, 6 zo 115 or 230 V, 60 Hz, 1550 RPM, built in overload with 5 automatic reset. 4 • EP05 Single phase: 0.5 HP, _ EP05 115 V, 60 Hz, 1550 RPM, 3 built in overload with EPO4 automatic reset. 2 • Power cord: 10 foot 5 standard length, 1613 1 SJTOW with three prong gr oundin g pl p ° 0 0 10 20 30 40 50 GPM roundin lu O foot length, 16/3 SJTW with three prong grounding plug - -- (standard on EP05). 0 2 4 6 8 10 12 m /h CAPACITY Goulds Pumps ® 2000 Goulds Pumps ITT Industries Effective February, 2000 03871 STANDARD CNAMREH Quill Standard Chamber -- —48" I i (EFFECTIVE LENGTH) 12" F e Eli l 34" - - - - -y SIDE VIE SECTION VIEW MultiPort End Cap 12" I \ 1 1 - -T - -� 1 �—<- -- -- — r j SIDE VIEW - fop VIEW FRONT VIEW ��11 Ln *I it � Qulck4 Standard Chamberyomtnal S�eciticatioils ,t MuttiPort End,Cap Nominai Spectications� ,.,_,:: Size �W x ( H �' ` ` "' r-• '3q° x 52' x 12 . r " Size W x l: "x N) Effective Length 48' Invert Height 8" or 1.25" invert Height 8 „ INFILj -A SQR SYST S. iNC STAN L IMITED WA RIAI Ia) The glructural rIItagr:t, of bath the :narnlyor. arw .Siato, wvf O a d �, uu accessory real „ taclumrl by Inkicl slM r'Urats "1 when nrslar!ed arrtl I:lTarair -vt R'r 1 tea a W an h n i ) ;(), ysinlin n acLU da �a +Ih NM r - a, r t rli Cf:a ,_. - befall to (ha orja,nel pprChaaef ('HO m to al' li i we kma6 I'll iv T a Ye' %.r lrorr th dal f' a! It rr Np, pe r r a li e_l to tl a wpttc SySlmn contai'i ll et Unils, PrcY�r1.:J` h That gltl r. ilemlN 4 U! rY4ureJ try Vti" Abla '' w, Iha wwr; —, parkxl w1� t eq upa the data ihe! _,a401ipn of the G pw, n rtV, npxtres. Tu e ts ra lY ttG. Fk>Irkir rr"�st notify f: at!v U at IS nO le iHa k7 1 - n V SaybrtxW, nneclk.uif wdh'"r fifteen (Ifj day / Y,e IayexJ 1 N . tnfltrator w61 SuPV Y I phd :am9rrt 1 5 far U "N, d ,Inert by Intll rdtrx to D? 4`OVarad Ly lhi5 Llrt4led Warranty (♦ . • fit 1 dIJ Iralu-41 —1-11 spaClkdly s 1"T t 1­,! arnbor msia fa- x r • l;le UnIls Ib1 T1IF UMITI WARRANTY ANC, RENIEGIES tN SUHPAFAGPAPN (a) ASE LXGL'JSI& I .Hi}1 ARE Nt. 01H R WAHRAN11F.- WIT i RESPECT T o }iF -Mrs, IN( Li1E INcj NO M LIED WARRANTIES JF MUi FANTABUT` OR r0i A PAF.TIG 1.AR PUR:Y)SE, due SYSTEM /� r""1 � NC 1 I�"�I Thin L r let VV r mty J1a.11 L nc1 Ir anY hart of if e u�u�ba sy. tern rs n unl lach"e l y nyona Otner Isar hdtlnata The Lrtr +l 7;l Warrar;y tlOas T i C i \ V / i V = t f n h u rknld - rnscq e t al, sfxlcaal x "direr =l d n ages 1AIr.dO 59x11 n01 h Fie to! Pry a Ie a Gyuivatau t a5, , WUln LOSS M Ial O : +,x Iro 9r J PrOIR i - bc,r anJ InA;erials, 11.1heai coils, )r olra ,Jsse Or GXOI nSoo ncur nil by the I try: ]a. rn any third par . JneGfrv-;alV ErnfranmeirW Onsrfe Wastewater S&U,%l�rs� rtxcudud frr 1 l.frn t?ri 'Na— nly p Braga are Carnage to I�'.e Unlr i» to Oldinery wear a. J tea, . tl arai0r , a0Cklanl Tnsuue. abu, or na4dad of the 1 the Jli IS Mi Ig S1gau rtl to vtN1Kk traffic. or Other C.On. t xis w 4h are no P", f by the Slelati0rr Itrst Jcbo u. IaAue to rnaimetn Irq mr: tun dmunU crwers sal fort r n e :nstallal on inseUr,CGris tike u,u;amnr or inprnpe blot als into ,ha system contan g S':e Jn fa�lre 0! 6 Business Park Road • P.O. Sox 768 u'P Wits v the sePli sy5ten': u'mpKKrar Slam or Inxxopor iziny, axr.OS:,ivn wotal 1 .ryuOpar crOase rrl6ya5al, a improper Oparatil:;n, a err; o h =,r ovens not ccosad by Inhlt al n: Thin Llmnx Werra: +y r.J,aB ho vad a ire Hol;ic f / > aonµuy with all of rte terms sal font ��n Th v urr"tarJ Old Saybrook, CT 06475 War _ ov 860- 577 -7000 • FAX 860- 577 -7001 In r - Vr en 1 all i l a dtor t a rc�apO HOj a rlu �np I(g„ a UanuUa : it '& tl 9 Units C., any tMnl party resuNin4 Irom ,rstal afore b` Jrlp ^'�E/�� 1P��ryry A rna O fr any Ur wd 1 Hab'ndY claims bf Hn,da a 'rny fYs 1 pant rot ft Ie 3 rtite7'Narrar ty 1O aPpryt Gte Uflns mast ba r9siallad n ac ^wr};vlCg 8 tI1l�LC �4Y3� with 211 fife OCxirAttO. 3 rec{uirari b•7 date &nd'rra, Lrges; all other app,;c;tLVe awc, ana Infwra Or„ elSlaliaLUn p75Ir{Y,IionS. IJ; Nu r q r antalva Oi InllAratOr na, Ux nal Holnor aulncri!y to change a eal"'O th" L",med Wananly No warranty appies to airy pany other than the o4 p- TIrI auuVa raprasar 1 the Slanifard Limtlad Wareanly oRereU by kdlirator A 11-19OG humbar al states and COLIIAMS 1.1.0 OJf wananry .c rarsrire near s. eery purcha �r ,( 1}yts should <rrr tact InNnrator r 's Corporal. Haad,luangr6 m Old : aybrook , (�orttleChcW, Pr10r t0 such purl uae, to ablate fl X,pY of !ha appiabk walrerriy, Wri should catef l6 mad thal warranty prior to MIa purchase of Uni15- -�.S. Polortts 4,769 bbl 5.017.041 6, 53360 ).407 fib r,]14 9 u 511 903 5,716,103; 5 , 5 64, 7 78;5,639,644 anadtan P tents, 1,329,9E-9; 2 OG4 6(�4 01-re pater f; ram <f rq {nfnlralor Eavaiizer acrd SideWtnjer are registered trademarks of 10iitrator Sys Inc. Infiltrator is a registered liaLYermark in France. Infiltrator Systems Inc. All IS a registered Uaderrark in Mexico. Contour, COM04ir 3vAvel Connectwn, Microl -eaching, Poly ruff, SnapLa;k, (:11alrt+arSpacer, PtiSiLock, QuickC%A. Quick Play and 0.:ick4 are trademarks of Infiilrator Systems Inc. 0 2001 Infiltrator Systezmi Inc. Printed ill U S.R. NECYCLEU PAPER ST CROIX COUNTY SI✓PT'IC TANK MAINTENANCE AGREEMENT • AND ONVNE; SHIP CERTIFICATION FORM OwncriBuyer St. Joseph Development Corporation Mailing Address 12415 — 55th Str North, Lake Elmo, MN 55042 Property Address (Verification required from PIarming Department for new construction) Cityl tote To of St . Joseph, WI Parcel Identification Number J,EGAL DESCRIPTI ozo - Z 131- «- cTo /° Property Location NE Y,, sW 1 /4, See. 23 . T 30 N -R 20 W, Town of s t. Jo sey - Subdivision Settler's Glen , Lot CertiIIed Survey Map # . Volurne , Page # Warranty Deed # 7 0 0 5 6 9 Volume Page # Spx house 0 yes U no I.ot lines identifiable El yes Cl no SYSTEM ;��I NANCE . Improper use and maintenance of your septic system couId result in its premstum failure to handle wastes. Proper mamtenaace consists of pumping out the septic tame every three years or sooner, if needed by a licensed p+naper. What you put into the system can affect the function of the septic W* as a treatment stage is true waste disposal tystem. The, property owner agrees to rabmit to SL Croix Zoning De cut t certification four4 signed by the owner= and by a mast erplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspectioz and pumping (if necessary), the tcptic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above rcgWrements and agree to maintain dr- private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin.. Ccrtifi. cation stating that your septic systear has been. maintained taust be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNATURE OF APPLICANT DATE OWNER CERT.f1 QATION I (we) certify that all statements on this form ate true to the best of my (ou) knowledge. 1 (we) am (Pr.* -) the ov mcz(s) of the �ri eve, by virtue of z wumnty deed recorded in Register of Deeds Office, SI ATURE OF APPLICANT DATE s.ssss Any information that is mis- mpreuatedmay result in the sanitary permit being revoked by the Zoning Department_ "• "« •` Include with this application: a stamped warranty deed froth. the Register of Deeds office a copy of Lite certified survey nup if reference is made in the warranty deed i 1 2 0 6 5 5 9 8 -700569 KATHLEEN H. WALSH Document Number TRUSTEE'S DEED S TGC XGco. , V 1 RECEIVED FOR RECORD HENRY J. LENTZ, as Trustee of The Henry J. Lentz Family Revocable Trust Agreement dated May 24, 2000; and Bernice A. Lentz, wife of 1202/2002 01:0eP1! Henry J. Lentz, for a valuable consideration conveys without warranty to EX9PT t ST. JOSEPH DEVELOPMENT CORPORATION, a Minnesota corporation, Grantee, the following described real estate in St. Croix REC FEE: 13,00 TRANS FEE: 4390.60 County, State of Wisconsin; CENT FEE: FEE: PAGES: 2 See attached addendum. This is homestead property Recording Area Name and Return Address j LAAID TITLE, 1NC.<D 1900 ." - CAD W.7 I-IN 55112 MA N4 61i " 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 '-�`? 4 day of 2002. "Henry J. L Trust *Bernice A. Lentz AUTHENTICATION Signature(s) � �, „` ,� ACKNOWLEDGMENT STATE OF WIS(;ONSIN "r"� La �� ST. CROIX COUNTY i� Personally came before me this _ day of authen ' led t is day of 1 O O 2002, the above named Henry J. Lentz, as Trustee of the ' Henry J. Lentz Family Revocable Trust, and Bernice A. signature Lentz, to me known to be the person(s) who executed the foregoing instrument and acknowledge the same, type or print name TITLE: MEMBER STATE BAR OF WISCONSIN signature (If not, type or print name authorized by " 706.06, Wis. Stats.) Notary Public St. Croix County, WI THIS iNSTRUMENT WAS DRAFTEE) 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 Trustee sOeedSfJosephOevelopment -02 OOUNlY PLAT OF: SETTLER'S GLEN LOCATED IN PART OR THR?(WV4 OF THE OWN, PART OF THE NE114 OF THE SW114. PART OF TtM SCIA OF TM SWI14, PART OF THE NW114 OF TM S8114, THE 6WV4 OF THE SEV4 OF SECTION A AND IN PART OF TIM NEV4 OF THE NW V4 OF SECTION 26, ALL IN T30N, R20W, TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN. ---------------------------- THE FWKWIGATIONAL TRM. EASEMENT GOWWWUMM 11 7 NO THE OONGENATCN EASEMEM --- --- --- — – •---- • --• - -- -- SKNM ON 1�08 RAT AM CONVENED TO THE TOWN OF Fr. J09041L ....... .. ........................................... .................. ............................................... LOT • Lcrr 7 1 1LOCCAPINS AgxxAmm • LOT a asoD Acleo LOT • J -------- .......... ............................. ..... ...... .......... . .. ........... . LOT a IS • S*WA=W .6 LOT . ORAN am Fr. LOTS . WWA--OX4 ...................... ................... ......................................... ....................... KWU-00" Lcyr 410 8= ADM KW�-G= sm ........... ...................... ............ A. ........... ........... .... ........ .... ......... ...... . LSA-80U sm AM=' loam as FT. Vil .1'a AIIDlINOfW p' 47 &000= LOT I* &OCRAa amm Lar 12 C•.. 0 � `♦ '�� ♦ \S \ 9\ \ ,soave as n. I 47 1 IL N Lcff Is LOT I* 17� 4 , Lerr 17 40 LOT Is STATE w .01 w ST. SUHL sma THE V&T tL=TCL a—win AND ACTING s" LAND SURVKYD#G INC. IIGAICt or a CA EL . SO � CONIVY THAT VNE A. — ,V�Apmmw T. THE L DICLUM 0 TNE MAT *we" J ♦ DauHATSAw. Tr VAIL' MW voAm NFM SHEET 3 Ora Lcrr I f a �' •• • • 130 SO. FT. SAMM BM W "= •'� elk f , •, do po . f LCrr 1 ■ • w • 1 r 131%M SM Fr. . • + • N � • w + V + I• . • • ♦ ♦• i• •• • •• • •• •i • • • • • • • . s go 6 Ng • ■ • •• . . a � • f . . • • • . . • . . •• ••• •••• MG Ng • r ■ t o a • • . am"WIN o f .,