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HomeMy WebLinkAbout030-2131-32-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: uATTAH TO PERMIT) 453117 0 GENERAL INFORMATION ` 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 Dev Corp St. Joseph Township 030 - 2131 -32 -000 CST BM Elev: Insp. BM Elev: BM De cription: If Section/Town /Range /Map No: In t o vc, PI 23.30.20.1086 TANK INFORMATION LEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 3 Z06 o Dosing Alt. BM 5 DO Aeration Bldg. Sewer Holding St/Ht Inlet A) ,- 76 8y TANK SETBACK INFORMATION St/Ht Outlet -- — TANK TO P/L WELL EB . Vent to Air Intake ROAD Dt Inlet Septic r1t7f" Dt Bottom 33 — aS, 8o Dosing Header /Man. Aeration Dist. Pipe S0,jr, 9, S Holding Bot. System j0- fo M 6a4e PI- B 1,63 9 y Final Grade PUMP /SIPHON INFORMATION Manufacturer S Demand t Cover der„ - f I Z Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length I bia. Dist. to Well S SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches — PIT DIMENSIONS No. Of Pits In napth DIMENSIONS .^t 't� 0 cttlo I SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION J /� UNIT Model Number: CHAMBER OR Type Of System /� , YC� 04 3 � 7 , DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake i/ q Pipe(s) LDia Length Spacng SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded c ed Bed/Trench Center / Bed/Trench Edges / To _ es COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: _/ �� ! � Insp --+ Location: 1429 Thelen Farm TR Unknown (NE 1/4 NW 1/4 23 T30N R20W) Settler's Glen Lot 32 Parcel No: 23.30.20.1086 1.) Alt BM Description = 5 T Cam^ ( 0 W, U1 Le. !� t d !_K On n 014- 2.) Bldg sewer length= 33 (LIl pv � ,h� Z.4,_J i1 - crl 5 - amount of cover = ? P la n Use other l side for u additional information, No SBD -6710 (R.3/97) Date sepctor's Signature Cart. No. N o- 0 o Q DSO . va @ 0) ° e � i I k � , , 7 � § i � § � ` to / / 0 ° & e' $ \ S - 7 E # m # / o § § R$� �'a 2 £ ; - =r / & o n o H w § ] c ° < ° c 6 \ /m ƒf CD = z > C E �; � [ e > � E m o: 3 © @ 2 % (D \ » i 2 / ' n k k \ § E C \ § IT z 000 / / \ 2 2 CO) 0 \ ƒ / 3 CL \ \ Z ƒ C . z " 0 § } [ § { \ o / ƒ c ` k k ® » o 0 � \/ i�k� _ m 0 CD ; ¥ z $ . 0 M Co E m m \ § 2 \ z N) k 0 . / ® � ° I msU) = =e=E�> =n (n nCL — ��=Rg =®® _ CD r k\ -CD =(a f - =Em /E)E'E § 2«040CD ƒ R 7m a= «CD 9 0 o —��� oE. �] /Eik }§ ]$EE ®3°° =R[�\Z , kg2 E §E= �)§�'� § W 87�7mx }3 $ § \- % J o / o m ,, % §f = \ � ƒ / ƒ � G � \f \ } o � � 0 � rM / ; 3 ! J %;6 k ID � } ' ® ■ m - z C:' & } Z $ CD ¥ ¥ k / �\ WD/ E(� -4 CD 0 §k po t , CL � ° o o ¥ @ \ k E E 0 k 8£ o (§) / © M />£ % 3 7 0 § 7 ) , M 4 \ 2 ƒ� « § § - n CD 2 k% A rr R �o z 0 0 0 =! .. Ott § N } § CA § \ < \ 2 � 7��\ � E & CL I l i p g % o_ CD E (D �I 0 .. / 0 } \ E; \ § \ � ƒ g � E ` ƒ k z ) n Ec -q CA & U) - R E 7 � § ) 0 .. T f § > ( z § � 7 CD � » ,- cn = =ecsa> =R '< 0E-, (n n CL �E © +'G+2£& k \��\ \j /i§ @aI\E]$0 /} % @ CD0 0 (D I ro 2 /ƒf¥ =�«0 # /i (\ {E\ g )ƒft {7 \§ !& = kR�A� =g2 0 ; � CL ;7 IX . =[0 cb0) k 8 0crMwM 7 � && ® fo� CL k ° CD k � ;__ � � ■ CD / I Safety and Buildings Division County �' I p� 201 W. Washington Ave., P.O_ Box 7162 i� ` �On�,� Madison, WI 53707 - 7162 Permit Number (to be filled in by Co.) Department of Commerce () 266-3151 3 Sanitary Permit Ap hc�IVEr) �� �LD. In accord with Comm 83.21, Wis. Adm. Code, pms*W information you provide _ may be used for secondary purposes PrivaeY (d different s15.04(l)(m) Project Address different than mailing address) i n 1. Application Information - Please Print All Informs ' l L� �� A W1 4 SRN i � l �tYY Owner � a u��w � �� �, � FI CE Parcel # Lot � Block # 15 � 3 Property Owner's Mailing Address P A I Property Location D 3 ' 2 - 3 / I � �T N /� �,,� V., S..iou City, State Zip Code Phone Roger LK Lpto tit 5 5U (Q�j _ - 3a T 3o N; R - (9&E o 11. pe of Building (check all that apply) 2 Family Dwelling - Number of Bedrooms i � am Su�b�div_ision Name CSM Number ❑ Public/Commercial - Describe Use ❑ State Owned- Describe Use / �G vC.� / ❑City ❑Village �&wnship of Ill. Type of Permit: (Check only one box online A. Complete line B if applicable) A New System ❑ Replacement System ❑ TreatmentlHolding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New list Previous Permit Number and Date Issued y� Before Expiration Plumber Owner IV. Type of POWTS System: Check all that appl ,KNon - Pressurized In- (mound ❑ Mound ? 24 in of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressuriz In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Leaching Cara Drip vel less Pipe ❑ Other explain) V. Dispersal/Treatment Area tion: Design Flow (gpd) Design Soil Application Rate(gpdsf} Dispersal Area uined (sf) Dispersal Area (f) System Elevation 4b ✓ '7 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Talcs Tanks Septic oP+Rflg!ffJ-ra� v Ul FFC�'T-T Acrobic Treatment Unit Dining Chamber G l� VII. Responsibility Statement- I, the .4ir,igne$4 ... responsibili -for installation of the POWTS shown on the attached plans. Plumber's Name (Print Pf s MP/MPRS Number Business Phone Number 1 000 I rSL 1 9,35- oZb Plumber's Address (Street, City, State, Zip Code �5�°I - 7o 2 V11L lm /De artment Use Onl proved El Disapproved star Permit Fee (- hides Groundwater Date Issued 1 Agent a (N s) Surcharge Fee) 7� of/ El Given Reason for Denial 4 1X. Conditions of Approval/Reasons n for Disapproval �,. J Attach complete #ans (to the Comity only) for & system on pa am less than SU2 x if imehcs Im size SBD -6398 (R. 01/03) s� -Tos 14 1 ,16 �-I� �► S� vdt v rs r'o "? 3 2 `vT C fDrtir �'D, C Opy r" 4-vG9r,)7 l000 1 4 -01 s T l'),4-61 t / u gEP I �I,t) I� ' ate-- . � ---- -- �rU (am) Fw Tor or I" PAIL F'(e. _ l� T P ,1L CO 19 FROM CERTIFIED SOIL TESTING FAX NO. 715 233 0398 Jun. 14 2002 05:52RM P3 w E &YU E kPROOV LOCicawra CGV6R JUNCY►or+ AL4411Ww6 A IJL Qusci,C Dcscaw��ci ---� i N k 1'YC � � y IJf /�i D196. 3' Pvc ks. I I p syDsgTt}R6EL1 � S`D1L. 2 4 ° T -V- 4� 4" 40 Vi; NT I tot Appa -ov t? A p CET - Mjhfr5 _.— _ p,AFFI.E � AL rt6r- T10A4w °`y et `? s„Q, • 1 V I �j;0uuo b �t tvv�+prT',c La�V. j f".40GK 5EPTSC a A _ PE C. I F 1' I��� 805E �, L�,•cw.`� TA 1lr5 MAiIUFACTUQ.CR: `4 WumerR OF 004ES: PEA DAB TAWK. $JZC. thro " GQ'L'S 6ALLOws . .005E VOLUME ALARM l�llJU1JFACT13fCiwit' S J 1 ��c'�Y,r INCLUOING ISACKFr.OK: 0. is ^DOeL lJU"'9K*, �`�` CXPACITO: A = 2 9 WCHES OK 1 132, c.A��ous sw► l'!.H I `JFC'. �•�• •`�ky Z ` IIiGH$S OR �' B Cr�,LLGUj PUMP MAWUFAC.TUR£K: �fi "LL1 — .�_ IuLMES OR GA'..LDL:S MODEL WUMDCR: 5fh 3D D �_ k kill He OF, 19 ah'�t;.,,� SwITCK TkiPC: Ytit�v•.+.v •• - .L^TE: PUMP Au0 ALARM ARc Yo 5E: M11.f I 11L!!''� QJ50�{ R ATE �_ G FYI INSTALL-ED Ou SE PI,0.ATC VERTICAL D bcrvfCClJ PUMP OFF Aijo mjSTjtjbUTIOJJ P IP£.. 6 2 1 FEET �^ + l'k'UI#kUM WETWORK SUPPLY PKt&SUPL .. ` O FEET �7 + FEET OF M FORtt AIW X ,3R P Y n?Z lFlttcTI*WFA,CToit, 7- fE£T -� 'rOTAL ObWAMIG HEAD = 17 a F>-Er V :UT£RMAL D)ME)JAi4114 Of 'rA&jK: G.CrACPTH , ��;W,DTH t - ;LIQUID DEPTH �aL.c 6 e I Wholesale Products Page: 6350 -1 Performance M3/4H - Section: Performance Data Data Dated: January 2001 2 RPM: 1550 Discharge: 1 -1 /Z" Solid N NN oc 12 40 9 30 W Vf 1..1.. GC Z \" : 6 20' J SHEF 3 ` 01 0 Capacity -U.S. G.P.M. 10 20 30 40 50 Liters/Second 0 1 2 3 The curves reflect maximum performance characteristics without exceeding full load (Nameplate) horsepower. All pumps have a service factor of 1.2. Operation is recommended in the bounded area with operational point within the curve limit. Performance curves are based on actual tests with, clear water at 70° F. and 1280 feet site elevation. Conditions of Service: GPM: TD H: 1 HYDROMATIC' elf Safety and Buildings Division County 201 W. Washington n Madison „Wl S 707 -I$E CEIV tart' t Number (to be filled in by Co.) v iscosln (608) 26 3151 4 53 , than mai en to P1 LD. Number �*� ! t of Commerce Sanitary Permit Application * APR 1 2 2 ccord with Comm 83.21, Wis. Adm. Code, perwrul informadon y u provide Law, s15.04(lx ) ect dress (ifdi$'event ling address) may be used for secondary peapae os p ST. CROIX COU E NI 1, Application Information - Please Print All information �4z t_1�11� T�l41L &reel k l.ot k Bleckyr� p ny Owner's Name 5 r_ c �aiAMddres .e Ytal'eiVl. WL y ),o�don propert y 0wuer's s l s `� ST 1 N y %, Section l l\+ Zip Code Phone Number city, state „/ ,�, 6 �t (circle one) �xTO� a "o f ” ' 3T.�JT T 0 R� E oO Il. Type of Building (check all that apply) v' ion Name CSM Number or /i'GQ �rwt 2 Family Dwelling - N Bedrooms !�• ff z a s; k( ❑ Pub4c/COnunercial - Describe Use ity_ ❑Village tel.t o wnship of S�t ❑ State Owned - Describe Use tAA - 0 o- 2 3t 32•- ill. Type of Permit: (Check only one box line A. omp etc e B if applicable) S stem �.,� ent/Holdia Tank Replacement Only Other Modification to Existing tm A. S ❑ '� g S ❑Rep Replacement Sys Y�New Sy t list t P-mut ip ued B. ❑Permit Renewal ❑Permit Revisim Change of 0 PermitTrttas5erto �V P Owner Before Expiration 1V. Type of POWTS System: Check all that a I Z �` 00 - Pressurized ln- Ground C] Mound > ❑ 24 in. of suitable soil [3 Mound < 24 in. of suit& a soil C] At C] Single Pass Sand Filter _ Constructed Wetland ❑ Pressurized 1n Ground ❑ Holding Tank ❑ Peat Filter ❑ A Ic Treatment Unit ❑ Recirculating Sand Filter ❑ Aecirculatirt S thdic Media FUtc ❑ oamber ❑ Dci ❑ Gravel-in t ❑ Other lain V. Dispersal/Treatment Area 1nf0rmatlon: Dispersal At Required (s Dispersal Mee Proposed (SO System Elevation Design Flow ( Bpd) Design Soil Application Rate(gpdsi) Pe IS- 2 f 6 �� tu turn Prefab Site ( Steel Fiber Plastic f vi. Tank Info C� ity Total Number Gallous of Units I Concrete Constructed Glass �+ ►� New 8xistina Talcs Tanks Sc�iic u�}1i+ ^� WD �0c> Aerobic Trcauncrz unn Dusinµ Ctwmbcr V11. Res nslbUl Statement - 1, the under ed, a s aslb for installation o he POWTS shown tan the attached fans �� N Business Phone Number pJ (Print /� PI 's Si bAD L i A) V4P X39 Z 1- 7f - C-- Business (� S� Z3 ZL.�C� Plumber's Address (Street, City, State, j C 9 4 �b0 0 /�� elil D Nil � / �• �. Vill. Count 1De artment Use Onl ksuad !s uin gent Signature (N Stamps) Sani Permit Fee (includes Groundwater Approved Disapproved Sure ge Fee) 3u ❑ o wner Given Reason for Denial IX Conditions of pproya SYSTEM OWNER: 1 Septic tank, effluent filter and 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 Attub Complete plans (to the County only) for the system on paper not less than 2 l/2 x I Ioehes to size SBD -6398 (R. 01/03) S 7 dos r- p 14 4✓e 5 1 -o ppv et4 T A16 Svv a 3 30 � w T, �� v S�� os tph SIF�-et- 6-1-P vl -,) boQi v iS i o ✓r 57 CTDr �v, I A'-. TT I ou o A--1 u P - I oo � 3 B €P o° l � . �NsfiavJ � - 2�g � log U-- 1 4 � pRl I roo' i �wt� V Tor o r l" PAIL r ►= +4 i 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 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 Tint all n o vi d by Date I n Personal information you provide may be used for i econdary purposes (Privacy Law, s. 5.04 (1) (m)). k3)4 Property Owner Pri perty Location !-G 2 b 002 Q �-rk E� l� U E 5 G Lot _$(,j 1/4 5G 114 S z3 T N R z Q E (or� Property Owner's Mailing AddressJ L # Block # Subd. Name or CSM# �S ( 0 �fi 11 w City State Zip Code Phone Number ❑ City ❑ Village El Town Nearest Road HNI Z c 51 ) L43 - 2 -9 < h 3 s/ New Construction use: [�t Residential / Number of bedrooms 3 — y Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material 6U 4 1 roc S K Flood Plain elevation if applicable ✓t/� n• General comments S S f C m e lC L1 g S. Z C) and recommendations: C°°QQ ctt° F • ?M � ❑ Boring # E] Boring ® � Pit Ground surface elev. /OU• 3 ft. Depth to limiting factor I in. Soil Application Rate . Horizon Depth Dominant Color Redox Description ETe xlure Structure Consistence Boundary Roots GPD /ftz_ C C6 in. Munse II Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I & -10 I C� r 31� Z k n Cs I � 5 �8 2 k YY) Coo Z Boring # Boring pit Ground surface elev. tV - 3D ft. Depth to limiting factor 3a in. Soil 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 I -5 I� I S 7_r�a m c5 Ivc 2 5 5b 1 1 2rr bk, M 'r c – q 3 - l �+ — c oS cr ' 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) ignature CST Number Acl m 5c r - Z,5 33c9 Address Date Evaluation Conducted Telephone Number 2113 STS S+ SamevSel,(l)I �`fOZrj �_�� — GZ ��15)2`�7 -�C�c� ' 1 Property Owner Carrl Parcel ID # Page 2 of Ili 3 Boring # ❑Boring •, ®—plt Ground surface elev. R Depth to limiting factor 3G in. Soil Application Ra Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bo : • _ undarY Roots GPD/il In. Munsell Qu. Sz. Cone Color Ge. Sz. Sh. •Eff#1 •EM12 cs 1 v 5 Ir < l.Z X3.6 F-1 Boring # ❑ Boring 11 pit Ground surface elev. ft. Depth to Limiting factor in. Horizon Depth Dominant Color Redox Desaiptlon.., ., Texture Structure Sail Application Rai Consistence Boundary Roots GPD /ft= In. Munsell Qu. Sz. ConL Color Gr. Sz. Sh. 'Eff #1 'Ef1ii2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. R Depth to limiting factor in. Soil Application Rats Horizon Depth Dominant Color Redox Description Texture . Structure Consistence Boundary Roots GPD /f In. Munsell Qu. Sz. ConL Color Gr. Sz. Sh. 'Eff #1 •Eff #2 Effluent Ni = BODs > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/l and TSS < 30 mg /l. The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608- 264 -8777. S869130 (ROTM) i PAGE _OF 3 NAME (`ci r 'ct c�1t TOT# 3Z LEGAL DESCRIPTION Y Sj t o ,SZ T 3o N R Z-0 E(or�U SCALE: I"= z/O 13M I ELEVATION /QU C) BM I DESCRIPTION 0 o 1 ', vG BM 2 ELEVATION Se� z 3 BM 2 DESCRIPTION 1 SYSTEM ELEVATION 9S Z U SYS'T'EM TYPE Ooq U-f A- 6a+1a. CONTOUR ELEVATION 14 -C) d- l09 • S- �o D � e Slop< �Jb 6� f 1 ,pml SIG ATURE , DATE Y ,�, _....... _ � mil[ J►� X - ,. 91 �? `4 . � .....,...�� .� _- x x 43V ' 9,8.2 LOT x .. ... .- .• ( x (3.00 x r:. 919.2 ® I � ®- .......... ................ x \ •' I 921.4 - x 1 x� 918.5 908.7 X.917.2 . �t I --------- - - - - -� e� LOT x 915 x • ACRES 918.4 - I 912. X /4 VE OF THE SWIM OF SECTION 23 sECi10N 2* vEOF � NWIA of SECTION 26 -f � i - I P A . � � r 4 n The Standard Infiltrator" Chamber The Standard Infiltrator Chamber �-•— 1' Overlap at Latching Mechanism T - — T 12' o ;� D i m ' 75' Effective Length Chamber end View PoaiLock'" End Plate. a � F x cm ., Storage Capacity . ,.77:5' gal (298 L) 17 ®�O O. O po o .. . ..26 Its 11.8 k pQOO 0, O °O Weight .....:.. ( 9) o 0 @ 0�0 3 4• — = Louvered Sidewall Height .......... 6" (15 cm) INIFILTRATOR SYSTEMS INC. STANDARD LIMITED WARRANTY NFLTRATOR SYSTEMS, INC. flrttaatah STANDARD LISaTEA WARRANTY FOR SEPTIC PRODUCTS 1MSthhac"aal Yta¢ty d each doobw and and pits wo m mamW by' N , (wind ly wlsrted loss U tsl w1m Yetrad «d operated In a Ia1101M10 d an asks seek Ffimn In aooadrm cash narrors YasnYdan Ymudom Is wrrtad to the ovw pardww rHObetl agree - do - ' 's rd vmrbno whp for one dl yyaar tmh IM dme upat which n sW k permit B lmtwd 1« Me septic sY. aarrhMhB lha uahYs roMdr• ■ . • ■ hoaervr, dw y a septic peasst is not mquked its to septic syseem by apP1u04 Mat tear (1) yea weeny period wi boo upon the des time h ubWn d to septa system mrrahharhoss. h order to aherdse werrarty d9hts kidder new "Is, aiNUetar n veitlrg r ft caporea hhxdquertrs eh Old Saybrook Ca«mctlnt, wthin Manse den d th aMgW detxt kAtraem WE ahlpecarrhert urs w dmse tMts aletanheod bIr nRdat« b be ddedhe Witt `herWby tits Lkftd (15) �nrt't` aem"°°.�„'�.dt°" rh� e coo d`an�.' wKftiwm`a«' a theme. SYSTEMS INC till THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH I ARE EXCLUSIVE. THERE ARE NO OTHER WARRANTIES WITH RESPECT TO THE UWM v4CLUDMC NO LWVMD WARRANTIES OF MERCHAHGBILRY OR FITNESS FOR A PARTICULAR PURPOSE. a TM Unlyd Waffw q does not aesod to exidathtd, msepwWel. spadd a VOW drtmges• tfltiator shot that M hole w parheMies « 41 En yjmn�ntal IOnske Wwfemler SOIut ions f Eviow duhig loss a hind pmts. labor hind ahrrrkR owhrd ears « anher base s « espartses ehn11had by de tloNer a arty third lcaly axdhdd air n LyMed Wrratty ewrage Ls damage so the Urs duo b adthery weer rM car. sterron actltlat. maim. adore or , uah� ,M utk: e.l erga�e b wtaa ae�a «dlmr a mom whie�h r. ^a v.am�tae b leteom towucdom 1+011 b Meek- 6 Business Park Road a P.O. Box 768 nrm ¢had covers sat ham n tlr eertetlott esthalloaU: tr phoerrtert a ehptaper hhotetea ehb dm syswn cwaftg do Urft free a "' °i ' r ° �b, wit r„ Hwnr mihpy wnh Y a 011 ,et wte wws ,trer,.i Old Saybrook, CT 06475 o avan sir ettaaax a tn{,oreele m any Lana artrpa b sm ImaL eta tide «any cad pry �t im sae awerton or ehiwn11nL 860 -577 -7000 a FAX 860- 577 -7001 prodaet IatAty dens d Hader «ry tlid prLy Fa the Uetrd Wrrrty b to Urns mh6t ba kotied eh aoeaMrhos w� h r sYe aFied by wt rd Waal codes r atlw appar�Cle ewer and Uiltrasortc YsteYtlmh� � iobuctkns. a Fb nprnrtativa d ktamta hers tw ralhotig b dtraga nor Lbftd wins ty in any corner what osm.. a w hard tea Lit, ied ft " 1- 800 - 22 1 -4436 No wrrrty 11pp111S b any P11nY air em tlr tr4erl 1laldr. Tmalx ro p, ss, tsteskwWwdLkn k*d w. arty~ byrtwrm. AUr. anmcerasausrdoamhonMw A/et.rtr+artrKyr114w^o^�• WWWinfiltratorsystems.COn1 Any p rd w a Units skald oatau wka11ws rnrPorar hh11110gherr11111 n an 5eydodc, Commcft& Prior to such pffdwe• b obtain a Dopy d tm spPtrahl11 weeny rd sthohrd hyrakay ahrd tat werrty pbr b =pads d Utis etisala sylrrm don nor ism fwd kWm" aUM syslra under pav "NM Ghand m mux be emrat aaxarig b Mwwb ues trunctiom I*" t err smwdng b nra8aeers setructiom we void money Yial11r System ahecatrattatds to use d septic tank tests rd Ymdry veers welt as aUke septic systmw sysrtt siq Is t by gm- wpmar i=or technical.assistance,Ilnstallit on instructions or customer4eml; i .call Infiltrator Systems af`.i 500 -22 "-4 U.S. Patent: 4,759.861; 5.017,041; 5.156.488; 5.995.017; 5.401.116.5,401.45t 5,611.903; 5,716.163',15.588.778; 5.839.844 Cwwdlan Patent: 1.328.959; 2,001.584 QMwr pftertls perms• tdflLrMOr EqueMxer end SidelArnder aro hepistrod tidemrks a d kAft r Syaterte kr.. IMdtrabr is a ropbtro w d tradenk in Fr4ylce. klAltrsbr Inc. t s tedemark M Mexico. CaRDtt. k6wd-"&&V. PdYTD(f, Simi CMmberSpaoe6 POGLOck. QUidCAA n POWTS OWNER'S MANUAL 8z MANAGEMENT PLAN Page Of FILE INFORMATION SYSTEM SPECIFICATIONS Owner -Sr tto(rp d og a Septic Tank Capacity ppp gal ❑ NA Permit # 4 5-3 I I -} Septic Tank Manufacturer i4ww ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Zwe ❑ NA Number of Bedrooms „3 ❑ NA, Effluent Filter Model ❑ NA Number of Commercial Units o ff NA Pump Tank Capacity gal -ErMA Estimated flow (average) 30 a gal /day Pump Tank Manufacturer .2-NA Design flow (peak), (Estimated x 1.5) S-C) gal /day Pump Manufacturer .EMA Soil Application Rate 0 - 7 gal /day /ft' Pump Model 4B'7VA Influent/Effluent Quality Monthly average* Pretreatment Unit 27NA Fats, Oil iZ Grease (FOG) 5_30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter 5_220 mg/L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BODs) 11 Disinfection ❑Other: Total Suspended Solids (TSS) s150 mg/L Manufacturer Pretreated Effluent Quality ❑ NA Monthly average* * Dispersal Cell(s) Biochemical Oxygen Demand (BODs) 5530 mg /L 14t - ound (gravity) ❑ In- ground (pressurized) Total Suspended Solids (TSS) s30 mg /L ❑ At - grade ❑ Mound Fecal Coliform (geometric mean) 5510' cfu /100m1 1 ❑ Drip -line ❑ Other: Maximum Effluent Particle Size A inch diameter * Values typical for domestic (non - commercial) wastewater and septic tank effluent. * * Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every .2ta ❑ months 2('year(s) (Maximum 3 yrs.) Pump out conten of tank(s) When combined sludge and scum equals one -third (PS) of tank volume Inspect dispersal cells) At least once every 0 7/ 0 ❑ months 4 year(s) (Maximum 3 yrs. ) Clean effluent filter At least once every J ❑months year(s) oG as Inspect pump, pump controls &alarm At least once every ❑ months *.year(s) ❑ NA Flush laterals and pressure test At least once every ❑ months ❑ year(s) ❑ NA Other: At least once every ❑ months ❑ year(s) ❑ NA Other: At least once every ❑ months ❑ year(s) ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) 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 cell(s) 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 (%s) 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 ch. NR 113, Wisconsin Administrative Code. The servicing of,effluent filters, mechanical or pressurized POWTS components, pretre ?ternent comporkerits, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by it•certiifled PQWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of fpmpletion of any service event. ,a START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents ,.v .t,e .,.,L,<<1 rmm��ic hv 3 cants OP fPlVlftnO 11 nr inY t!1 IICP. 7 Page ` of Z ' System start up shall not occur when soil conditions are frozen at the-lnfiltrative'surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the, dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS 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 dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down 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; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABAN DONEMENT When the POWTS fails and /or is penmanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with ch. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • 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 re a ement system: 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. » ❑ A suitable replacement area Is not available due to setback and /or soil limitations. Barring advances in POWTS technology f. g Y 1 a holden 'tank be installed as a last resort to replace the failed POWTS. may ❑ The site has not been evaluated to identify a.sultable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ 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 AND /OR 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 IMP( IVUR1 F. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAIN R 01111- FLUIVISING; INC; Name •L. SINZ PLUMBING, INC. Name ' P-5699 798thAVE. ' Phone E5609 708thAVE. Phonel MENOMONIE WI 54151 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Agency 4WIAl I Phone r 5 r a ct}u y SEPTIC TANK MAINTENANCE AGREEMENT :-AND OWNERSHIP CERTIFICATION FORM OvmxriBuyer St. Joseph Development Corporation Mailing Address 12415 — 55th Str North, Lake Elmo, MN 55042 Property Address J Aa^ I r cc I (Verification required from Planning Department for new construction) City /State T own of St. Joseph, WI Pazoei Identification Number Se Attached Deed LEGAL DESCRIPTION' Property Location NE Y., sW t /4, Sec. 2 3 , T 3 0 N - R 2 0 W, Town of j Joseph subdivision Settler's Glen , Lot # .� Cert feed Survey Map # - _ Volume . Page # Warranty Deed # y 0 0 5 6 9 . Volume D __, Page # Spec Rouse 0 yes i6 no Lot lines identifiable V§ yes 0 no SYSTEM MAIN MNANCE Jatproper use and nmiatenanec of your septic system couId result m its prturt failure to laaudle wasbcs. Proper =h t=ance consists of pwaping out the septic tank every thrte years or sooner. if needed by a licensed pumper. What you put into the system can affect $e function of $u septic tank as a treatment stage is tiro waste dispoml system. The property owner agrees to vibmit to St Croix Zoning Depertincat s certification form, signed by the ownerr and by a =asterpiumber, journeyman Plumber, restricted plumber or a licensed verifying that (1) the on -site wastcwatcrdisposal sysum is in proper operating condition and/or (2) after ii spection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the uadersignod have read the above requirements and ag = to maintaia 6c private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Rerources, State of Wisconsin- Certif catioa stating that your septic tystem has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 da , year expiration date. SIGNAT1.1 OF APPLICANT DATE OWNER CERZTI rQATTON I (we) certify that all statements on this foray are true to the best of my (our) Smowledgt. I. (we) am (err) the ov-Mc.-(s) of the propertydecrn above, by virtue of a warranty deed recorded in Register of Deeds Office, L? ; 5 SIG'9ATURE OF APPLICANT DATE s" • ss Any information that is xais- mprescated may result in the sanitary permit being revoked by the Zoning Dtprstment "' • •: • " Include with this application: a stamped warranty decd from tht Register of Deeds office a copy of L certified survey map if rtference is rmade in the warranty deed J 2065P 5 KATHLEEN B. WALSH Document Number TRUSTEE'S DEED ST. CROIX , W, 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 :00P1f Henry J. Lentz, for a valuable consideration conveys without warranty to EXERT # 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: 4390.60 ty COPY FEE: CERT COPY FEE: PAGES: 2 See attached addendum. This is homestead property Recording Area Name and Return Address LAND TITLE, I F OAD 1�I v I I .�] G 155112 I " No. 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 ' ' Bemire A. Lentz AUTHENTICATION // ACKNOWLEDGMENT Signature(s) 2 C� ✓� A '� li STATE OF WISCONSIN er ✓► -r e- A. LQ �2 ST. CROIX COUNTY .11 Personally came before me this _ day of authen ' ted t is � � k day of 0V 2002, the above named Henry J. Lentz, as Trustee of the +< n Henry J. Lentz Family Revocable Trust, and Bernice A. -P` AX .Y Lentz, to me known to be the person(s) who executed the signature foregoing instrument and acknowledge the same. 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 7rusteesD eedStiosephDevelopment -02 2065P 599 Property Description - (Henry J. Lentz Family Trust /Grantor to St. Joseph Development Corporation, Grantee) A PARCEL OF LAND LOCATED IN PART OF THE NW 1/4 OF THE SW 1/4, PART OF THE NEIA OF THE S W 1/4, PART OF THE SE 1/4 OF THE S W I /4, PART OF THE N W 1/4 OF THE SE 1 /4, AND THE SW i/4 OF THE SE1 /4 ALL IN SECTION 23, AND IN PART OF THE NEIA OF THE NW1 /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 0 59'28 "E ALONG THE SOUTH LINE OF THE SETA OF SAID SECTION 23, 1329.95 FEET TO THE EAST LINE OF SAID SW 1A OF THE SE 114; THENCE N00 °05'53 "W, ALONG LAST SAID EAST LINE AND THE EAST LINE OF THE NW 1A 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 1 57 1 '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 S009 7'14"E A DISTANCE OF 304.14 FEET; THENCE N89 °41'28 "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 °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 °52'23 "E, ALONG LAST SAID EAST LINE 1324.16 FEET TO THE SOUTH LINE OF SAID NE 1 A OF THE NW1A OF SECTION 26; THENCE N89'5 5'00"E, ALONG LAST SAID SOUTH LINE, 66.08 FEET TO THE WEST LINE OF LOT I 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 l 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 SWIA OF SAID SECTION 23; THENCE S89 °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 35/64 AND C.T.H. " E " AND SUBJECT TO ALL OTHER EASEMENTS, RESTRICTIONS, AND COVENANTS OF RECORD. COUPIP` PLAT OF: SETTLER'S GLEN LOCA7EDINPABTOF' IIG; NWVIOFTNBSWV {,PABTOPTNBNBINOF9tIBSWll1, � \ R� PAATOF' fNBSBV40FTN66NV1 ,PARTOFTIBNH7HOF'I'�SBV1, iHBilYll40F /� � :� ,,,,, THREV40FSBCF30 AANDiNPARTOFTBBNBW0FMNWL40PS &MON1f tettHEeit xoTe ALL INT31k RAW, TOWN OF ST. OSBPN,ZCROIXCOIM,WISCONSIN. '` K 111EMkrIFApWl1R1l61SEtEMt /1 ` w/ i NOIIE'IA1pI1FASE1ENl : •aAm� sllawaMnttFlATxt:mMhlm ,•.• :a MOIEM4MOFST.J M. \;:. d f \: d !�'' `'•`\ i 1 LOTH i win .. , I MSK ............ LOT \ i 1 �aNn MADD ., \ I Mb S`, LOT 31 1 tnAgAOR. '� :�\ \'•. \ '•:'I f + l 1� ! • tK caoi'•` / \' `_ , r �`J .,Y•'. ' '`. \ \`' ' � , !�arwMr wM�, / � ' "•" �I i 111 I '; r` . ,r ''•......,.,.. ': \y � i ' �''• �� � i 9 I�. I 7 ------- rawsw lOTi1 !" LOT 11 i I f #j jg ` ANA 1K pR. FI! 1111 �� i t wNU[arAw r'' qM ....... ........:.......... 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AIO+L It7elr i I WMFr 1X11 N 1MNIMIM HM M IaMIK N q QTML 1j R q MNO fA'af N 7PQ0. Atal00Rt q E I l I N.I1L Mry 19A MW 119 •�� � I� JOiIF DFtM FA/LMLFIF OETAtt nA� --�- -- a1K v N MAISdF • Al " °a ttuimv a p� SANWt�DSUAYRYDiCR�C i q TOM MOM I"My ca un N K nf!� M, WMMEOON +4 K/ r"MOVIRI MIN KdMINMN M Ap![ NYO WINi11p, A K MOM K K M !gaol , � ( "flow ,' �MgenlA/A100un�aw NO OOMIO M IN[00 NtIMINrt, /q A K EEw 10 K . 30 RSC011 N 7W WMAT01 MM VMMAK1 w t IIAP / `\ wunAVeea K M 106NMra1n MM Xmw tiME1 q SdbEQC)I1U19K1JIDtlb11C _ / lam .( •l� ` MpMVNNM . N W IMAM l - tIMMeMMNMp \ � aMtexol\eaneM \� EMNMNMNMnAa � 1M11MylElMtM WNFW r.10 I NMKANAMmgI of E I SHEET 4 OFR wob do T ARE CONVEYED Jt�SEPH. 3EI ..................... . ....� '•• • Syr .... ? —�••�, lo l tc LOT 32 1 3.000 ACRES 130,881 SQ. FT. 10 SAW W • _ . LOT 31 •' 3.000 ACREB 130,883 SQ. FT. SOUTH UNE OF 'Iii SW SOUTH IA 1h OF 80G'I10 n ........ ......... :..................... ............. SOU TH L NIE OF THE SEW Cif SOMOM M aci m � SEC. m 1 '� ,aaoel I