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030-2131-36-000
P vdisconr' Department of Commerce PRIVATE SEWAGE SYSTEM county: St. Croix Safetq an Building Division INSPECTION REPORT Sanitary Permit No: 515065 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Permit Holders Name: City Village X Township Parcel Tax No: Wasieleski, Kurt I St. Joseph, Town of 030- 2131 -36 -000 CST BM Elev: Insp. BM Elev: BM De ription: �/ Section/Town /Range /Map No: 10k - 7g A0 7 ' r6r - 13- - - dLf�.� Kato 23,30.20.1090 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION ,3S HI FS ELEV. 5. /z z— 71 r Septic (ti. "" 1 _. _.._,_ t +,`�`• c Ca�Cf61.sG �73•� �° 7 Dosing - i t s - �r It. BM ��( -,X 2• `r . ....,.� bb« a,. s..t,. "a.- Bldg. Sewer lie Holding St/HtInlet j c� TANK SETBACK INFORMATION St/Ht outlet TANK TO �, P//l, WELL BLDG. Vent to Air Intake ROAD Dt Inlet i Septic � ` f �a � Dt Bottom Dosing ^+ .. Header /Man. 3 �� �� �• Aeration U Dist. Pipe � Holding Bot. System Final Grade PUMP /SIPHON INFORMATIONS - ' { ''.L �• /> Manufacturer - Demand St Coves ,- Y- t � .. • • GPM �" . - ar.... ,.._. *, ' •Gh.. Model Number � ff /b3 if t oo jY . h � 7 TDH Lift ,, Friction Loss ISystenn Head TDH �Ft Forcemain Lengt j Dia. + Dist. to well CL OK�►�l SOIL ABSORPTION SYSTEM BED(TRENGH Width a' Length No. Of Trench & PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer: l INFORMATION CHAMBER OR Type Of tem: , + .# UNIT Model Number: DISTRIBUTION SYSTEM / 1 es ,.,:•� s�a'� .. Header /Manifold Distribution +f s x Hole Size f+ x Hole Spacing Vent to Air Intakg I if Pipe(s) Length Dia y Length 1 Dia Spacing �-- G' / SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over r _ Depth Over xx Depth of / xx Seeded /Sodded xx Mulched Bed/Trench Center a Bed/Trench Edges Topsoil < Ff� Yes [j No xes No t COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1:�l/ Inspection #2: Location: 1408 Thelen F rm�Tra_il Houlton, WI 54082 (SE 1/4 SW 114 23 T30N JR20W) Settler's Glen Lot 36 Parcel No: 23.30.20 .1 0 90 1.) Alt BM Description r 2.) Bldg sewer length = z ;,) �� `! ' - ._ �,fl 5 ) ►� 4T - amount of cover Plan revision Required? Yes x o Use other side for additional information. LG' s Date Insepct s Signatu Cert. No. SBD -6710 (R.3/97) Safety and Yiuildings Division' 201 W. Washington Ave., P.O x f2� �/ S�� �� Madison, Wt 537 - l Permit Number (to be filled in by Co.) pslNtitaf COIMIINI00 Sanitary Permit Application Tea a S with s. Comm. In accordance 83.21(2 Wis. Adm. Code, subjnission of this forth to the appropriate governmental unit is required prior to obtaining a sanitary Permit Note: Application forms for state-owned PO►W Proje�tAeldras (if different then mailing address) submitted to the Department of Caoamerce. Personal iufptmation You provide May / 7�/�� Vom in accordance with the Pdv aw s. L 15. 1 m Slats. Y, a Information - Please Yhimt All Information V 2 Paroet # Property owner's/ MAY ? 6 6 3 Q - 213 ! — 3 (p - �O property Owner's Mailing Address N1NG & Z011 \NC' / s �Q CJ Lot t � .7 -3 Ci State ty, Zip C at Number Section G �k o 10L Type of Baildtag (clack all that a�Pl►tY) A 1 of # KS Subdivision Now or 2 Family Dwelling - Number of Be mo C� �� O C �) •..SL_ e'M loch i ❑ public/Commercial - Desenbe User "'� ❑ City of ' CSM,j)h more ❑ page of ❑ State Owned - Describe Use own of-� $ k 75 i III. Type of Permit: (Check only one box online A}. Compie to line B if applicable) f t ❑ T neatment/Holding Tack Replacement Only ❑ Other Modification to Existing System (-Plain) A. ew System ❑ >� Sys i 1 � List Previare Permit Number and Date Issued � f B. ❑ Permit Renewal ❑ Permit Revision Change of Phnnber ❑ Pemit Transfer to New G�IJ D3 Before Hxpiradon Owner d IV, of Y'OWTS S tomlCom nent/Device: Check all that a 0 Non - Pr hr- Ground ❑ Pressurized In UrOund ❑ At -Grade ourd >_ 24 in. of suitable soil ❑Mound < 24 in of suitable soil essurized 0 Holding Tank ❑ Outer Dispersal Component (eucplain) ❑ pretreatment Device (explain r V. Dis rea Area Information: Area Requi (sf) Disperael Area system Ekvado Dear . Flow (gpd) Design Soil App 3 D p, � 6' VL Tanl:Info Capacity ir► Total # of Manufacturer v Gallons Gallons Units d New Tsars Tats y rs+ C'�7 f3, Septic or, Holding Tank + Dosing Chamber VII. Res asibility Statement -1, the undersigned, ty for hutanation of the pOWTSMr� tunber Busies Phone Number p ,,.a,..,• NOMM (Print) � � Pt 's Si i Phunber's Address (Strut, City, Stan, Zip Code) VIIY. C 1De eat use Onl Permit Fee Date ,q Issuutg Srgmahtre proved Disapproved j $ t2 5 veal Reason for U IX, Condittbalt for Map vai 3� �e n.Q; �i it c "� t. t auo-C� o CAA4 J. Septic tank, effluent fiher and dispersal cell p �, , � must all be sermes�� maintained �, �� s t..+` �-�.� S as per management plan provided by plumber. I I 2. All setback requirements must be maintained Attach to ewmpkta plans tor' 0 system sad seb the C M I eely on paper Mot lam In s ll iacbes daa SBD -6398 (R. 01/07) Valid duu 01109 PLOT PLAN PROJECT Kurt Wasieleski ADDRESS SE 1/4 SW I /4s 23 /T 30 N/R 20 W TOWN St. Joseph COUNTY ST. CROIX SYSTEM ELEVATION 101.7 .9 sand lift 4 BEDROOM CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 760 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers BENCHMARK V.R.P. Top of steel pipe ASSUME ELEVATION 100 Filter BEST GF10 -8 ❑BOREHOLE WELL *H.R.P. SameasBenchmark North Property Line 3 Acre Lot Sole = 11'4° = 10 Area 15` below system is to remain undisturbed Well is to meet all , 100.8' setbacks found in Comm. 2 83 Grading is to be done to divert run -off away from system B- B -4 163 4% Slope Tank is to be properly bedded and provided with lockdown covers with approved warning labels A B - 1 101' ,100' 9 B' Huffcutt Combo tank Pro 4 Bedroom House X50' Property Line � �� Thelen Farm Rid PLOT PLAN PROJECT Kurt Wasieleski ADDRESS SE 1/4 SW 1/4S 23 /T 30 N/R 20 W TOWN St. Joseph COUNTY ST. CROIX SYSTEM ELEVATION 101.7' .9' sand lift BEDROOM 4 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 760 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers IL BENCHMARK V.R.P. Top of steel pipe ASSUME ELEVATION 100' Filter BEST GF10 -8 ❑ BOREHOLE WELL *H. R. P. Same as Benchmark North Property Line 3 Acre Lot Area 15' below Scale = 1/4" 10' system is to remain undisturbed Well is to meet all 100.8' setbacks found in Comm. -2 83 Grading is to be done to divert run -off away from system 163' B- ❑ B -4 4 Slope Tank is to be properly bedded and provided with lockdown covers with approved warning labels El N B -1 101' 100 99' 98 Huffcutt Combo tank Pro 4 Bedroom House 250' Property Line Thelen Farm Rd - Safety and Buildings commerce.wi. �V 141 NW BARSTOW ST FL 4TH g WAUKESHA WI 53188 -3789 Contact Through Relay isconsin www.commerce. o Department of Commerce www.wiscnsin.gov Jim Doyle, Governor Richard J. Leinenkugel, Secretary May 06, 2009 CUST ID No. 226900 A7TN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMIC14AEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/06/2011 Identification Numbers Transaction ID No. 1662454 Site ID No. 744538 SITE: A�j Kurt Wasieleski Please refer to both identification numbers, ./ � Thelen Farm Rd 1 j above, in all correspondence with the agency. Town of Saint Joseph, 54082 St Croix County SE1 /4, SWIA, S23, T30N, R20W Lot: 36, Subdivision: Settler's Glen FOR: Description: Mound, 4 bedroom Object Type: POWTS Component Manual Regulated Object ID No.: 1224253 Maintenance required; 600 GPD Flow rate; 26 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual - Version 2.0, SBD - 10706 -P (N.01/01) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, stats. The following conditions shall be met during onstruction or installation and prior to occupancy g p P Y or use: This system is to be constructed and lo i y a ed n accordance with the enclosed approved plans and with the Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD - 10691 -P (N.01 /01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD - 10706-P (N.01 /01). In the event this soil absorption system or any of its component parts malfunctions so as to create a he. th lyd, the property owner must follow the contingency plan as described in the approved plans. In addition, comply with the operation, maintenance and monitoring duties as described in section III of i4$ P°tfent manual. A copy of this information must be given to the owner upon completion of the p "ect. All holding/treatment tanks are to comply with Comm. 84.25(7)(a). C� O Maintenance information must be given to the owner of the tank explaining that periodic cleaning the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. SHAUN R BIRD Page 2 5/6/2009 A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stars. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. I • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101. 12(2), nothing in this review I shall relieve the designer of the responsibility for designing a safe building, structure, or component. Beginning October 1S 2008, small wastewater holding tanks with estimated flows less than 3,000 gpd that are based completely on approved POWTS component manuals must be submitted to the appropriate governmental unit and will no longer be accepted by the Safety and Buildings Division for review. Please refer to s. Comm 83.22, Wis. I I; Adm. Code for further information. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sinc ely, Fee Required $ 250.00 Fee Received $ 175.00 Invoiced Amt $ 75.00 Julia Lewis- Osborne This Amount Will Be Invoiced. POWTS Reviewer 2, Integrated Services When You Receive That Invoice, (262) 397 -6005, Fax: (608) 283 -7481 Please Include a Copy With Your julia.lewis @wisconsin.gov Payment Submittal. WiSMART code: 7633 Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 RECEIVED I 715 -246 -4516 APR 2 7 2009 SAFETY & BUILDINGS Date: 4/ 25/09 i Owner: Kurt Wasieleski Location:SE1 /4 SW1 /4 S 23 T30 N,R20W Lot 36 Settler's Glen St. Joseph System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section /Pi a Layout i p p Y 5. Pump Chamber Cross Section 6. Pum p Curve 7 -8. Maintance and Conti Ian Yp 9 -14. Soil test Shaun Bird Signature License numb 26900 0 y ��2. pL F Date Non - Woven Fater Fabric 4" Clbsexwat;Zott Pipe Perforated ,Distribution PiP;! Below Filter Fabric � AS= 0-33 Sand G. = Topsoil slop e Bed O(f 2 % Force gain Plowed f '` r From Pvn+p i,, dYes • flrcEin Roc k , to i .t, r Grass Section Of A VAOund " stem Us F ..4y A Bed For The Absar tio� Area �' � k R A r i L F �. L rt pipe"'`! Fore Main v A a Frsim pump -�.. w.-.... �o t?t5ttib arc'srr R*aK Pipe 4 Observation pipe toca" ?errnas�ent Martce+r / pipe or Rods A B ed 'For The AbSO L Arlo pla view Of -Mound fttn pwforated pigs Data$ !� _ Verfo�atta Eno- Miles LOW" Oa ibiit� /� _ IieM Eq+ati Jte¢as r Ir r v - PVC Forge 1N0� ,tA E �,r �1ReR.L �� •ens Cel+e+sr:�nan PVC ado rT i rove r Lev x _.•, 1 Role DfaAeter ��� -Inch LAteral �" ,. InCh ) License Neer: i taifold IwAes Date: Force Min .. . ' IntdW # of holes /pip Invert Elentim of Lateral s . �. r.Y.• • $�R �! i?SS SEC�"i� AND . SP�E €FCA'�•xttr�S SE�FIC 'EA1tif 3If�` CHAM J UNCTIon Box COVER a Cis v� rjpj 1 £ IT 11f plo t +� Moll grow OR WAXQW- ' mob Ti O(V F 3 • �,► fNV INLET �S s • dn s ` OM ,. A C i SOW pow OiT PAD 757 11PA • __ • DWF- T"K rAr- 3r ca" DYQSE F r �'�, J BlIL• sizes -sol%mc CAL As -_.:: Fes- ws ,Lot *�Dm va mp C's' i?ZS'SR�so -now lts wxaED � vER'IECA . Dirre � ,Y ,g�sUR� Iflilvolo 7 iiT j7 x TMI. , ; D Sloss of L eg !f ee • t Seat Sy i4' i„&serJet 3104; Lf Al t 713 �u W2I ; WAY - W 9EH S CRIES SUMPIE:FF'LUE:NT PUMP ago +_ ' p I i I I w us ru iir<t llXgllo it >b0 # ! �w a /e�� ! w g1 111 xS1 Mls fk 1b aM 730 1010 70 V yt all s11mut � II I VI L � 9S � tilts 1Hi =W m SIR M i3 107D 71 to ffi 7!i 9Q a 81s zu81 SA9f10 � � yt its 7000 71 14 ww'm am Not o�aysOwl�M �t» sWw talr.su�� � Motor I a000 t�bo� a tooa a000 .fit I ter 10 VoYuot ABR _ 7�d 7 .55 Sb�tr Sew - Potixer Cord SS?W • csrbor► azed N>asl� • r � rVjOC� �/IPief I s Sos+m� Scee1• . ...�,. UppwskWm Ewl Haan a o• 'Q aim CO. a Ptw PEA COM r oom Inweaudamcka jAmdk a rim Sass _o7As ... PER'S NfAN��- & MQI+�►G�� � PLAN . pOwrS o SY'S'f E s P Tic S'' D NA �� Tardy � ? I III. 't10K SOpQC ,, J / a NA 0 NA Ilk P Cl ONA �berofOO NA Pu Tat c O NA o t� Liras Pt P TS � , �) NA c� Pump q NA Unit a Peat son n w sill " .430 rng/. D fuedt - Q ottw. FSK cM & oOINISM l F = 420 Mg/L 0 D' n - MA morMly snrersga" [gta II ground mew L a At-grade � Solids �) DOMI Q TOW S itteaf�i t t . vAkowwt� for �hdiamef�r s0*0maw L ' wNrs�= 3G "pW CE 9i"1i3�1"E Ssrvlc� Ftr4eY fa nreor:ttss s) � 3 yes•) 9=10,111 Etreed ps feast �Ce eYe y `� - (� of tank velu:;se �+ ores tlsr'd . yenk(s) �pmo{esed sludge a Maeura 3 yrs.) tns corsQtfia� when s) { ts� of tsnf<s) D cars once ev'e� pump carat least 13 ASS s) tnsped celf(s) qt feast once OVW Y D r[sor a (s) D RYA cimn ument f9ser At SOast once sonny 3 s) p tEA iraped lam vMp aferen At least once every Q Q yeaKs) p NA rtssste ,murals easel Pv8sure At Murat once 011 Q II yea�+(s) i3 NA °ar At least once evoy ' r n++srRUCTYQ�NS an kx*4 dotal � P&JM IMW MO W Pte: PAPSO gee a vieuW � and gyres send tas d� l up kV p -r ate to voiu C be v1�X ttse aa P 9 * *)r of rteutt art tt� D � o th Iv ' d ' Q � aboor.vow xs ft a n a r CQ or'r' ofd W o Wound SWftC*mffk' MM s on at ff; a aid Sam SeryW OpWSW gW di*Wd at of> bosh be r+elra°vw by s and MY 1 13. 1NV Add �� ar p�urb* PO At�"S cola �Y.a P fibm 'ihe � of O ko t ��y�ds of.�2 motifs ar less � � be w 'Otte local r� auffo* w hin 1 57ART UP aim oi�Anom pow'S �c t Ot tank4s) for ttw are For crew o art�• and/ yam to Loa d ham of tau rankfsl n0rr+avesd by a sepd9 . __ i � I S ystsm stad u p mall not occur,, so a•condifions a re *=en at the inftmdve f surface tip above nominal ti LeeV°ets. VVt#Gn Power is resCo�tr9d the exoa_ss i3 g r o tip tanks oetl(s; in one tacge dose. aveiiaaduV the �(s) and may tes "t in the � v the avoid thS ihra&m have the a u tents of the puar ft* rem by a bad of +ate s the efticrevrt PAP cvntacx s Plumber or PMrS M� to Servkh 9 open to "ties lg r to a Erl rnai)L� do P "P COrit s t0 restore r normal leV@ts vsF"fttirt lfie putr7ls tank tats WA dt wrsal rafts.. Do not d&e Or park Ov Or . 0699vrise (IsUb or camMM Do ng mys or park t of MW moclnd Drat -graQe soft absorption anew. the area wamn 15 feet down slope Redircgon or- elirnhudbrt of the Mom from the wjdexrafer stream may improve flee performamae and prolotu} the 6fe of the POWTS- ma tte butts; 4wndoms, cotton swabs: degraMeff, denial floss; drapers: dam: foceiitaBon di*i {scanp PMF) water, flail and vegetable p g � frog brkm fat R� of 9 Pmd� �. satv't$ry nap[di�s tampons: and aratersalletier A SMOONOMENT taken out of servlae the fntlovring sigPcs shalt idiki+rt m k>SSrrrs that the y � y the POWYS t� and/or is pearrtane�Y _ 83.33 VYisoortsln 1+�dln�nisssativrs Code= utdorwd in cornprrance with ch. Comm sy is pr+opetiira safety seraled. Aa to tanks and pits std be disconnecked and the abandoned pipe openings PAS TAa ni afi =U t9nics scut � shall) be removed and properly disposed of by $ Se~ Sen�ln9 oo OPMaWf s AftN r pumpkV, gg t2LL" tad pats shag be excavafled and removed or their c Ovens rcnwved•end the voW sgebe Mod WWI Sod, ,.� M or bmt soad matedaL COHTtNC�1CYPLANf Lip° if Pi?VIfYS fads and Minot be repaid tim foffown8 measures have been, or must be takek to provide a code co nprent mpbmnent system l3 A suitable wt's[+ 2 has been evaluated and maybe utilized for the location of a rep�n�t should not absorption �. The replacement area should be protected from disturbance and comp action be irtttuged upon by from existing and proposed strorctcrM lot Fines and welts. Fa@ure to +esuli in the need for a new soil and site evaluations a Suitable protect the r�e� zrOat Will r reptaoernent area. Repboetssent systems must comply with the rules in effiec:t of that time. D A suiQalsJe p f area is not avaltable'due to setback and/or soil Grriitatiorts. Barring advances in POW'CS teriiiroioyy a tank t asaY be IctsUtied as a fast resort t rep lace the failed POWFS. Up on farlune of use POWYS a soi[.and e sibs tits not bear:. ceya�4ed to identify a suitable replacement are a. _ site evaluation Imist be Oerforraed to locate a sukable replacement area- if no r eptacenw t area is avarilable a as a last resort to replace the failed POV' M holdusg tank maY be it>s�ted of the Diortrat at • and st-gtade tot sWocpdon g may be moonstructed in place fotiowhV nwwva l terns ust caom vrllh the noes in etrrct at heat tune_ ire scrrliBioe, of such sys m PlY � <<WARNINGa- SEPTIC PUAW AND OTHER TRF.Jl1'Y'lflfENY TANKS MAY CONTAIN LETHAL GASSES AND/OR WSE7FFIGLENT OXYGE�t. ' TREATMENT TANK UNDER ANY CIRCUA�fSTANCES. DEATH MAY DO NOT E3�tTER /l t3E,lf'TIC, Pt�MP OR OTHER RESULT: ,RESCUE OF A PERSON FROM THE INTIERIOR OF A TANK MAY BE DIFFICULT OR gAP OSS IBLE. . AUOMONAL C0NIKFF_1nt POMiR'S INSTALLER POWTS MAINTAMR Narrie Q � Name ,r hone f f'-- ��" j Phone P X SEPTAGE 55tYlC1NC t1PFRATOR LOCAL REGULATORY AUTHOR Y Name Agency - �'c9 Phon$ ? =-p2 Phone 71:is a�rnau woes QraA�ed try trrr st>rls of ttri Csl(+dstr Latta, Marrruetta and Waus a County Znalrg acrid S=4006 WrIder Thk doh Meets ue sr�i+imaa» Mquftnan" of m Cairun 83.2 ►J(bXtXfiBd� and 83.5s(I), () b (3), Wisoonsin Aektilnlstr 0 Co& fig's of V& doesaoeeit does a0 gna✓an0ee the poilommWe of ttie POWYS. 04/23/09 WU 09:09 FAX 715 386 4686 wool rwoarr�o�o• doaa�wa• SM. EVAL UA71ON REPORT _, ,-P.9. DNlota�d6i�N�pnd6�ialoR in V CoMpOk Mr. Adw. Ondr " ' s f : C,QDi' � • i�roboaoptwsw��aw ►os�tNs.lsoa ;t bon:ik.w. Pwnaxrt rdueRat�oe�.awM. Aar .atwroirMr.Mr�w�a.va�E� ��- .OjO� � �/• '7 6 p.isontsleR. sow« dgrnMww. � �noFwaMbosdana nrdMo � rsbor «sl Dsa I�r,� Pr3gtw�Jslbr�wMoa: °y /2! :... ri. w.. Mlr11�r�" ��I� •••o/�►•r..d.rwA�!1'- '�IrtA�..a u�.tgNM� ` ,i oHl+'FR 6,k�D�uey- - •�2'.�i. - (o .ltt : s•f ���: trf�ry ,�{u�SeN w l S.�fgv �rs 38t��.s / -.�:�: o � h.% �'' R ' Na�rOeNiudau iM�llUwibsrd6afeaoo - c�eeadwdati�ro•aa �° � -..�..�. - 6� � 4hbtosrsoaoawu�M -Osoa� ' +� gvSF" tr f ` / RECEIVED O Am aw t wawda. . ,! WWA(PAAwT.SJ •!d pro. / �Occ S CROX COUNTY sob* dYrwMaoWsax. 777�R WOM+bioN�Yi�trler._ -i-- -� ZdNI ' low% oeo 0 Nabs. � . 111MC0soa�Pd�. T.rtw. AMws •iit / a !o R. • $ o yie Rl -- /�- . G • 8 •? ID Y9 5741 .... G IL dye ctrl / ' — ! C a • s *AV /00.3L' aswiwr A.daso.�n T.r. M„w. e�rrww�a. "°oK IL �turwt Cb&ft osnc Osiar er. ss sn ...- z w G a Ctv " •�,R. .so ..dtst a9 •i�.rdq• s�9 sse ,.rTaa•oo ao csr Ns��lodss 'Z1 i�3R% tl, T'"! � s U lblicht No ig. hoc 7 � s • ?7� • 2. age Cansuftft 2812 10di Ave. Spting•VaHey, WI 54767 ORIGINM i ►�',��� ��rs ■rte �� ®�� IrA mow_ MIN" �eSssA ��r�r�rrr mo rl�ltr■■�►� ���r;�s�t�t 1D / � 43 �y 3 ro° b y,�� � � y 1 '� s vyg �'sT�p �N,Fo�M M ovuo c4.c.,�o�R � t.� - 99•.5"0'' ,¢ Mdhap SY 6 RECEIVED Nei APR 3 0 2009 � Yi n Wisconsin Department of Commerce ST CRO EVALUATION REPORT Page - of 3 Division of Safety and Buildings �tCfr wit�Comm 85, Wis. Adm. Code � County 4 � Attach complete site plan on paper not less than 8 112 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. 3 Please print all information. R eviewed b Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). / Q� Property Omer Property Locatio U- r+ tt- lo— Govt. Lot 114 A SZ T N R 2 0 (o W Property Owner's Mailing Address Lot # I Block # Sub d. Name or CSM# D U .5 sv, r may �' City State Zip Code Phone N ber ❑ City ❑ village Town Nearest Ro Construction Use. Residential / Number of bedrooms Code derived design flow rate e� � GPD ❑ Replacement ❑ Public or com at - Describe: Parent material D t°,td�d Flood Plain elevation if applicable �Z General comments �Q / b - '9Z r1 d n c /�Q "' � c L� � � and recommendations: Y" ,vim Q r /G , System Type / �F Vi+L � / / � r System Elevation 13J Boring # Boring Pit Ground surface elev. (.< / I ft. Depth to limiting factor in. it Application cation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 - Eff#2 0 104" 3/ L- 2- o ^ U d/" f . F] Ong # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDN In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 - Eff#2 Effluent #1 = BOD > 30 1 220 mg/L and TSS >30 < 150 ' Effluent #2 = SOD < 30 rrKA and TSS < 30 mg/L CST lame (Please Print) Si re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 5401, 715- 246 -4516 Property Owner _ Parcel ID # Page of Boring # F-1 ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/T in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor )n• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring ❑ Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon 'lepth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 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. SBD -8330 (8.6/00) Soil Test Plot Plan Project Name Kurt Wasieleski Sh Address 360 Sommers Landing Rd N Hudson Wi 54016 Cs 0226900 Lot 36 Subdivision Settler's Glen Date 4/25/09 SE 1/4 S W 1/4S 2 3 T 30 N /R W Township St. Joseph Fj Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of steel pipe System Elevation 101.7' *HRPSameasBenchmark North Property Line 3 Acre Lot Scale = 1/4" = 10' 100.8' -2 B -3 ❑ ❑ -4 163' 4% Slope �B -1 100' 101 ' 99'B.M. #1 98' 250' Property Line Thelen Farm Rd i e e z .001 M O C O A O - -� 3 g AL � = U O N N H LO C Q �_ � $� _ I-- W 5, m G m U M awa°� € mMr A w w Q t Z c; uJ CL 0 to Am � — � oti.8►- ac.� waw o �� c � $ 0 Z W � m > D D � Z v w o �. � z o V'o Lo o z _" J O , >_ c� � w t= z z W C.� w Z O _ J � z 0 m = _LL Cl) Q Q � z ° O W CE W 0 � � a: w 0 F- 5 �O w 0 LL L Cl) m 0 w J W �Z O w m� J o Lu z O a� --v�Q Wisconsir'Department of Commerce OF , PRIVATE SEWAGE SYSTEM County. St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: V 5 1 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Wasieleski, Kurt I St. Joseph, Town of 030 - 2131 -36 -000 CST SM Elev: Insp, BM Elev: BM Description: SectionfTown /Range /Map No: 23.30.20.1090 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding SUHt Inlet dZ TANK SETBACK INFORMATIO St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Botto Dosing Hea r /Man. Aeration i °` is Holding . n `Q PUMPISIPHON INFORMATION V )41 Manufacturer t?sJ Model Number TDH Lift Friction Loss System Head \� Forcemain Length ffia Dist. to Well h / SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Tr , Inches �\�\ Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WE to anufacturer: INFORMATION Type Of System \V` JR SNIT Mod umber: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing ent to Air Intake Pipe(s) Length Dia Length is Spacing SOIL COVER x Pres ure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth qver xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed/Tr nch Edges Topsoil Yes [] No I El Yes No COMMENTS: (Include code discrepen ies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1408 Thelen Farm Trail Houlton, W 1 54082 (SE 1/4 SW 114 23 T30N R20W) Settler's Glen Lot 36 Parcel No: 23.30.20.1090 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? 0 Yes 0 No I Use other side for additional information. SBO -6710 (R.3/97) Date Insepctor's Signature Cert. No. Al • Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 ,SCOnsin Madison, WI 53707 — 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 -3151 �� Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, W is. Adm. Code, person into 6 1 may be used for secondary purposes Privacy w, s 1� Proo jeectAddress (if di rent t mailing addr ) I. Application Information — Please Print All �f " ) `atioln 0 1 2 008 ' � 3 DEC G 0 ! '" � / . (P - cra-o Property Owner's Name L Parcel # lock # W4 -5 ! L E /r• -rT. CROIX COUNTY ZONING OFFICE `3 Z ' Property Owner's Mailin Address u n P P Location a 1 K WV oMM 11 L� U tJ"' 's L 1 /4 Section section 2 ' 3 City, Statje� 'jt� 1} Zip Code Phone Phone Number V IpSD� W' 1 ��G / r�LQ ' 73 / T ��N; R= 1 rW II. Type of Building (ch k all that apply) JI (i or 2 Family Dwelling Nu r of Bedrooms t ubdivision Name CSM Number y g- �f o f .Se ?YA's 6,1A , ❑ Public/Commercial - Descnbe Lft C1 State Owned- Describe Use ❑City_ ❑Vill age Township of III. Type of Permit: (Check only one ox an line A. Complete line B if plicable) •S A. )(New System ❑ Replacement stem ❑ Treatment/Ho tdin ank 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 / Before Expiration Plumber Owner IV. Type of POWTS System: Check all that a 1 O ❑ Non - Pressurized In -Ground ?Q Mound > 24 in. of suitable ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter El Constructed Wetland ❑Pressurized In- Ground Holdin ❑Peat Fitter ❑Aerobic Treatment Unit ❑Recirculating Sand Filte ❑ Recirculating Synthetic Media Fitter ❑ Leaching Chamber ❑ Drip ine ❑ Gravel -less Pipe El Other (explain) } V. Dis ersaUTreatment Area Information• Design Flow (gpd) A Design Soil Applicatio te( Dispersal AN (sf) Der Area Pro ed sf) System Elevation a v R D ispersal G 040 o 00 t� 6D goo• sa ✓ VI. Tank Info Capacity in Total Number ufacturer Prefa Site Steel Fiber Plastic Gallons Gall s of Units Co Crete Constructed Glass New Existing /� f �� �✓/ / 6 Tanks Tanks w Septic or Holding Tank ,+1 �f OV _„_, I &V e AACL 1 4„p Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, a undersigned, assume responsibility for installation of uh WTS shown on the attached plans. Plumber's Name Print lumber's Signature MP/MPRS Number Business Phone Number t2o�AT (Print) .7 7a - 3'1'0- - Plumber's Address (Street, Ci S e, Zip Code) VIII. Coun /De artment se Onl Approved ❑ v Sanitary Permit Fee (includes Groundwater Date su Issuing t Signatu (N tamps) Surcharge Fee) ❑ iven Rees for Denial /f� IX. Conditions of Ap rovai/Reasons for Disapproval 3 1 4„ tAn - 5 5� 1 ^. SYSTE OWNER: t. S is tank, effluent fitter and r �' G �'�•t'.r �t " �J1 �`,( -..� d' persal cell must all be services / maintained s per management plan provided by pkaly6er. 2. 11 setback requirements must be makted �� ss per epplic" code / ardinarlcas. Attach complete plans (to the County only) for the system on paper a less than 81/2 x I I inches in size SBD -6398 (R. 01/03) f F ! I i 9Q� "�� o F ► YAP Pe PA i i 1 1 Q ► w !l i a t 3 M 2--� The area 15 it. below the downstage edge of the YI it 91.E Soil Absorption System must remain undisturbed. r ,C � /.eu � goo• D � y L OF � �- S U,5 T eD 7 NIr, ®1?14 v..c�Q C 740 UR 0 , 30 2(31 "t 7z o A 4 9' ECOPY .o' I a fir: &4 SST t ° p ° F , � , A� 0 yR0 . �(.e�. g 9 i � Q 1 3 , ;, � PR OW e ll i 1 � 0 V" ft Cr CA c 0 t ih ft. w the d wn � The a rea Bela o sl a edg of the �p g SQiI Absorption System must remain undisturbed. D `I �a L 1 3 o vim© o v ,Q>° 100-5*0 30 Cj 15ACkloc ' Safety and Buildings PO BOX 7162 commerce MADISON W 1 53707 - 7162 Contact Through Relay i sco n s' n www.commerce.wi.gov /sb/ www.wisconsin.gov 4 tlDepartment of Commerce Jim Doyle, Governor Richard J. Leinenkugel, Secretary November 26, 2008 CUST ID No. 226375 A7TN: POWTS Inspector ROBERT W ULBRICHT ZONING OFFICE ULBRICHT & ASSOCIATES CO ST CROIX COUNTY SPIA 2812 10TH AVE 1101 CARMICHAEL RD SPRING VALLEY Wl 54767 HUDSON Wl 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/26/2010 Identification Numbers Transaction ID No. 1612831 SITE• Site ID No. 744538 Kurt Wasieleski - Dwellin g Please refer to both identification numbers, Thelen Farm Rd above, in all correspondence with the ag ency. Town of Saint Joseph, 54082 St Croix County SE1 /4, SW1 /4, S23, T30N, R20W FOR: Description: Mound Object Type: POWTS Component Manual Regulated Object ID No.: 1209249 Maintenance required; 600 GPD Flow rate; 26 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 101), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 101) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, P C stats. Cone A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits AP required by the state or the local municipality shall be obtained prior to commencement of DE M construction /installation/operation. DtVIS� In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review SEE CORR shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. �► HOLDING TANKS Beginning October 1", 2008, small wastewater holding tanks with estimated flows less than 3,000 gpd that are based completely on approved POWTS component manuals must be submitted to the appropriate governmental unit and will no longer be accepted by the Safety and I R6BERT W ULBRICHT Page 2 11/26/2008 Buildings Division for review. Please refer to s. Comm 83.22, Wis. Adm. Code for further information. �► FEE INCREASE Effective on December 1, 2008 Safety & Buildings fees will increase. Initial plan submittal fees are based on the code in effect at the time the plans are received in our office. Subsequent submittals are also subject to the fees in effect at the time of receipt of those submittals. Thus be aware that the indicated fee calculated on your scheduling information may or may not be correct, depending on the date of plan receipt. The full fee code change to Comm 2 may be viewed at http: / /www. commerce. state. wi .us /SB /SB- CodeDevelopment.htnd At this time we have displayed both the forms with the current fees and the forms with the new fees on our website under the Forms page http: // www. commerce. state.wi.us /SB /SB- DivForms.html AeterE Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 el Pri vate Sewage Plan viewer, Integrated Services WiSMART code: 7633 (608)266-2889, M - F, 0600 - 1430 Hrs pete.pagel@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. 281210th Ave. 9 Spring Valley, WI 54767 £,F , <,.,, 715 -772 -3442 frir� . PROJECT INDEX Plan I.D. # Date � &4 U ' Owner •Phone 715 • S-,3S/ � t Address 3( .5t�M i IAA), 946- /� ,q. IMP - VASDA:) Legal Description j_0 �- #�? s� 7LS G- �.P, •� ��,V .515 %f -SkJ % SA . 2 3 , 7 A) ,z 2.0 w ° ° • z r 31 • � � .� Town of sE, Z7 ©Sit: 'PjV ^ _ County C.S.T. R ,uL13 P(C f 1Z.Ce37-5 Installer R.7403kic47 -- Local Authority/ Supervision PROJECT DESCRIPTION - 71 / d • /V�w � ,vS 7' UC �i 0,1,) -- 1 �}- � (� p � as�-� t3 e - # . PtVIK v 0 � ro •S { i1�j:Ei a `.L � i v , �: r lCUfiw ➢f�� springy 1a', W1 54767 "° F Pg.1 PLOT PLAN VIEWS Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS (REVERSE SIDE DETAILS INSPECTION PIPES & FABRIC /TOP FILL DETAILS) Pg.3 PIPE LATERAL LAYOUT (REVERSE SIDE SHOWS DETAILS OF LATERAL CLEAN OUTS) Pg.4 DOSING CHAMBER CROSS SECTION & SPECS. Pg.S PUMP PERFORMANCE SPECS (REVERSE SIDE SHOWS PUMP DETAILS) Pg.6.0PERATION, MAINTENANCE REQUIREMENTS (REVERSE SIDE SHOWS SITE & SPECIFIC PROJECT DETAILED INFORMATION,UNIQUE TO LOCALE AND GOVERNMENTAL UNIT AREA) ' I The attached plans and specifications are based on the following approved manuals: "Mound Component Manual For Private Onsite Wastewater Treatment Systems " (Version 2.0 SBD- 10691- P(N.01 /01) and "Pressure Distribution Component Manual For Private Onsite Wastewater Treatment Systems" (version2.0) SBD - 10706- P(NO1 /01). epl 2 01 � Q o f � r o ?�i StRi�3uT�oa Ail ecSA G- , lrkcck�s s•s s pi P it.) G- oF 'POP sort I.v� - na, -- s ysreA vmi FORM To E• w / H Z- +•,v E 3 F << • Mao. 1 9 Topso� uu+ FORM y% s 1 o p E F OR CE W E t MOA'Poa U oER MA c 9q. 5 FT S) r-LEvArlo4s. FT lmvERT of l y 1ATIERM-5 /.O F . 8o FT. Top o F R o ck CY S Fr• y r /,� FT ., ' TOP °F � IATERAI5 PLAN VIE OF Mou.&3 -- 13E D FoRciz MAW A � FT- I L - - 13 /0 Fr K /a Fr 0 ____- - -- - .----- - - - --� 1 Fr - -- - - -i 1 —�--_ FT 15 a � Fr _ w fT - 1A ' BEPOF %2 PVc �At)n n To i AiOl RE lr},�" nf3SERVhT�oa FT k'D�.l �. �•�X.0 Pf pES PERMA,j t0T M AR kERS PPS - d RECQui BAS AREA - 'T AI'Lx Wh5t'E'F7 � �D 4 � /ll?J'U SOIL 101i 1 TRhTitlE C APAci Ty CP 5 �. Fr. PR•op o s E b BAs M AReA = (A + z� 2/ - - S.m FT. T1 D t�') PIPE LA yo c17 Fr F r X 3C*e, of P UCH VRR . T OTAL- V d t p V b I V M E ''L G A 15 • '�'` sr�,v c O 1 � N � �METER s OF N&7k,,vMK INc!{ES Z,. "F ,o,-RAL MAMIFoLo . I�.t c l� IFs FORcE MAw � I uc.t�Es P I ZuvERT ELEVATIOa � \ OF LATERAL 5 � SEE � i17 ��'S�' S E" SOP C� �b I PM i NAL C/O btr7741 -b L • 17 i � � L.. ���'i �� cam` PER F oR ATE p Pi QE o� s••Ty .g 5;Q R N►ouF All bRitl (3 U RR5 Y No IES IOCATeD o,J BOT OM spAcE E � au�t�,y a . D1 STRi [3uTtoN DISChAR & RATE' PO I Ac � �- -- h ArERq L CA� PAR O-�i S !�•ZZ .GAL o � _ TOTAL V i STRi!B0Tio0 'D15c H c--: RATE fin R 4. 7 pUG VENT CAP I Pf P VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MAWHOLE COVER D D t2 "M►U. I &'/ Cvrtt'vfc>(, If113E� GRADE ( 4" MItJ. COMOUIT -- --- - - - - -- �•0�.� _--- - - - - -- "C-yAr, nA. V • V PROVIDE i -- -- _ INLET AIRTIGHT SEAL I I I I I APPROVED JOItJ7 A INy I �� �. I I' I APPROVE J OIN TS I I %.J/ PIPE [1� ( I ZXTENDING 3' to ! � I I I ALARM ONTO TO SOLID 3 , JW'TO SOLID SOIL ONTO SOLIb SOIL B � 31 ZI a J sc� , go P c 3• I I oN C I . l .. I ELEV. FT. + ~+ PUMP --i SE 2 " D —� OFF `� D �lO�PE s� a p0/ BLOCK �(At j'CVA i RISER EXIT EXIT PERMITTED OIJL4 IF TAMK MANUFACTURER HAS SUCH APPROVAL --� SEPTIC E SPECIFI'CATIOILIS DOSE i TANKS MANUFACTURER. � � WM9ER OF DOSES: PER OAS j TAWK SIZE: Z 2� GALLONS DOSE VOLUME I7.Og' i ALARM MANUFACTURER: INCLUDING BACKFLOW: GALLONS MODEL kWA5ER *- CAPA I IE5' i INCHES OR GALLONS SWITCH TYPE: B = Z'' I OR GALLONS PUMP MANUFACTURER: O C = INCHES OR 1 3D GALLOWS MODEL NUMBER: L * 3 ' 7 Y2-w P• D= INCHES OR GALLONS II I . SWITCH TYPE: T NOTE: PUMP AND ALARM ARE TO SE MINIMUM DISCHARGE RATE GPM G INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. • A FEET fiqok �'PE S � Y = - + MIMIMUM NETWORK SUPPLY PRESSUR��E / . . . . . .. . . . � • 2 . 5 FEET F�iGLt k + FEET OF FORCE MAIN X F /ioo FCFRICTION FACTOR.. 2 • a FEET r TOTAL DyWAMIC HEAD = � ``� FEET II I i� INTERRIAL. DIMEWSIONS OF TANK: LENGTH...,L__L .;LIQUID DEPTH i THIS POWT SYSTEM SHALL INCORPORATE PER COMM. 83.44(2)c A PROPER ZABEL - j FILTER MODEL # �Z,+eeL Q j q SEPTIC TANK, per Comm.83.44 (2) (c) shall be equipped with an outlet attached approved filter device (Zabel fiiter). Tank shall have an approved above cover for co regular (every g manhole ground loc king 12 months or less) inspection & servicing by a licensdd service pumper. HEAD/ lu W 115 CAPACITY � , so f 32 105 CUR VIt 30 100 — 95 29 90 � 85 EFFLUENT 24.- 80--- MODEL and Q 75 MODEL 189 DEWATER/NG x 70 165 - 20 � 65" a Z 16 6o — 55 9 16 50 MODEL O 14 163 MODEL 5 186 _ 12 140_ � II 35 10 }-- MODEL -MODEL 137, 139 SEWAGE and 195 8 25 DEWATER/NG 6 20- - MODEL 15 MODEL 161 10 f 2 MODEL t 5 53, 55, f 57,59 2a -80 GALLONS 10 20 30 40 50 60 70 80 90 106 110 , 75 LITERS 0 80 160 240 320 400 22 FLOW PER MINUTE 70 "'137" Cas Ion Se e ,` ry "8 39 Bronze Se � es HEAD UNITSCM N Feet Meters Gal. Urs. • Automatic Or Nor:- AUtOInatIC. 5 1.52 104 394 10 9.04 74 300 • 'h H. P., 1 Ph., 115V, 200 -208V or 230V. 15 4.57 64 242 • '/z H.P., 3 Ph., 200 -208V or 230V. 20 6.10 36 136 • Non - clogging vortex impeller design. 25 7.62 6 30 •Passes Winch solids (sphere). Lock Valve: 26' • 1 NPT discharge. • Float operated, submersible (NEMA 6) 2 pole mechanical switch. •Automatic reset thermal overload protection. ZffZZ • Stainless steel screws, bolts, guard, handle and L arm and seal assembly. • Bronze motor and pump housing switch 3280 ON MiRm Lane case, base and impeller. P.O Box 16347 Mercury float switches are available for non - automatic models. Loullovift Kentucky 40216 (402),-778- 27,31 FLOW PER MINUTE Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retainsolids In the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum In the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs'lo be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, If such products are used they shalt be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction In the winter will promote frost penetration. Cold weather Installations (October- February) dictate that the mound be heavily mulched for frost protection. ' Influent quality into the mound system may not exceed '220 mg /L BOD5, 150 mg /L TSS, and 30 mg /L FOG. Influent flow may not exceed maximum design flow specified In the permit for this installation. The pressure distribution system Is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manual ISBD- 10572 -P (R. 8/99)) and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be In accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches In diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. _Continaencv Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be Immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption and dispersal media, and related piping, and replacing said component's as deemed necessary to bring the system into proper operating condition. Questions on the operation or maintenance of this system should be directed to your county zoning or health inspector. j�. I SEF. REVERSE SIDE Pg.6 FOR MAINTENANCE REQUIREMENTS SPECIFIC TO '1'i11S SITE, DESIGN, AND COMPONFNTR OWNER's MAINTAINCE OF SEPTIC SYSTEM POWTS (landowner) is reponsible for proper operation and maintenance of this system. Regular periodic inspections and servicing is necessary for the safe healthy operation of ; this system. The owner is required by code to submit all necessary maintenance /inspection reports to the controlling,aut;horities. G SPECIFIC CONTACT C}� t/ Zoe, AGENTS �/� � � r)C. 7• * Governmental authority/ inspectors: 7/5 • 396 D * Licensed installer, responsible for providing an operation/ maintenance "Users" manual: * Licensed servmce / inspection agent other than installer: ;Fad >sociates Pi Consultants 20 1 ? ),l "1 A ve. Spring Va.II @U, W1 54767 * Electrician, for pump, electric controls, wiring units: S l ec 7?? IMPORTANT OWNER MAINTENANCE REQUIREMENTS 1. Winter traffic (sledding, shovegring, etc.) across the area shall not be permitted, or frost can /will penetrate into the cell, freezing up the system. Discontinuos use in the winter-(a vacaction trip, resulting in no water use) can also lead to freeze ups. 2. Water conservation-needs to be exercised! Or system can be hydrolically overloaded and destroyed. This sys�em was designed for a maximum wastewater flow of gals. daily. 3. POWTS are not designed to accomodate wastes from a garbage. disposal unit, or any other unnatural sources of waste. Any introduction of such waste materials will overload and destroy this system. 4. If a power outage occurs, or a pump fails, it may result in a temporary overload of effluent being pumped into the. cell, which may adversely impact the cell (leakkge). It is recommended that a licensed pumper empty the dosing tank, allowing the pump to return to dosing the correct amounts. Consult your installer immediately for advice. 5. Neglect of the vegetative''cover (the cells insulation & erosion preventive) can lead to failure. Compaction or heavy traffic also can destroy t he system. It IS NECESSARY TO REGULARLY WATER THE VEGETATION OVER A SYSTEM!! Effluent in the,@ystem beneath IS NOT sufficient alone tO maintain a �.L 4 cover. 6. Periodic inspections by the owner, or his agents, is necessary. Inspection pipes and ports have been incorporated into the system: on the mound basal area (effluent level inspection pipes), cleanout terminals on the pressurized laterals, at each tip - for flushing and cleaning the laterals out. The filter system in the tanks (via a locked above ground cover /manhole). Only a licensed properly quali6ied person should be performing this work which involves health & severe safety risks. Evidence of effluent ponding in the system's treatment cell shall also be regularly inspected.. OWNER's MAINTAINCE PTI:C SYSTEM POWTS (landowner) is reponsible for proper operation and maintenance of.thi - s system. Regular periodic inspections and servicing is necessary for the safe healthy operation of system. The owner is required,,by code to. submit all necessary maint /inspection reports, to the controlling,aut'.horities: SPECIFIC CONTACT .AGENTS 54. Oe Or 4 C -y 24N j Aj1 * Governmental authority/ inspectors: 7/5 3 6 D Licensed installer, responsible for providing an operation/ maintenance "Users" manual: M p aZ �3 * Licensed sery &ce inspection agent other than installer: Ubric . Associates pvk c� �AtG Private Sewage Consultants 2812 `1 Oth Ave. Spring Valley, W1 54767 * Electrician, fpr pump, electric controls, wiring units: JbM IMPORTANT OWNER MAINTENANCE REQUIREMENTS 1. Winter traffic - (sledding, shoveling, etc.) across the area shall. not be permitted, or frost can /will penetrate into the cell, ,_freezing up the system. Discontinuos use in the winter.(a vacact.ion.trip, resulting in no water.use) can also lead to freeze ups. 2. Water conservation -needs to be exercised! system can be hydrolically overloaded and destroyed. This sys¢em was designed for a maximum wastewater flow of gals. daily. 3. POWTS are not.designed to accomodate wastes from a garbage,, disposal unit, or any other unnatural sources of waste'. Any introduction of such waste materials will overload and destroy this system. 4. If a power outage - occurs, or a pump fails, it may result in a temporary overload of effluent being pumped Into the. cell, which may adversely impact the cell (leak.kge). It is recommended that a licensed pumper empty the dosing tank, allowing the pump to return to dosing the correct amounts. Consult your installer - immediately for advice. 5. Neglect of the vegetative"'cover (the cells insulation & erosion preventive) can lead to failure. Compaction or heavy traffic also can destroy t he system. It IS NECESSARY TO REGULARLY WATER THE VEGETATION OVER A SYSTEM!! Effluent in the,eystem beneath IS NOT sufficient alone tO maintain a - 4 c ovwr . 6. Periodic inspections by the owner, or his agents, is necessary. Inspection pipes and ports been incorporated into the system: on the mound basal area (effluent level inspection pipes), cleanout terminals on the pressurized laterals, at each tip - for flushing and cleaning the laterals. out. The filter system in the tanks (via a locked above ground cover /manhole). Only a licensed properly qualiaied person should be Performing this work which involves health & severe safety risks. Evidence of effluent ponding in the system's treatment cell shall also be regularly inspected. P 1 '° / Wiso xvM Depo"ent of Commerce SOIL EVALUATION REPORT - -- -- page of Division of Safety and Buildings in ac=dence *ft Comte W. VWs. Aden. Code Attach complete site plan on paper not tees than 61/2 x 11 inches in size. Plan must County 5 kwkx . but not Nmtied to: vertical and horizontal reference point (BM), direction and Parcel I.D. O p , percent slope. scale or dimensions, north arrow, and location and distance to nearea road. 3 :V ,3/ - 36 • 4ab Please pilot all Information. R by Date P0=W WomwNon you t* m y tw uwd form► tNsaan (Privmy Pmpwvomw /N,e l • cost. LA SC 1/4 5 11a Z T 3d N R 2-p E t4jo property owners Address L )J & .. by i ' .. tot # Block # Subd Name or c , 3&0 .5 oM'M Ewe N • 3 Cn State Zip Code . Phone Number ❑ City 0 Vftp W Town Nearest PAW �uPS6 N W 15 yo /Cv ?l5) 386.53 51 sr. To.S�p ham -rh el iw (,New Construction use: 9 LResidenfiai / Nuunber of bedrooms Code dertyed design flow rate GPD O Replacement O Pubic or cornmercial - Describe: Parent material 400H R i NAF - Flood Plain elevation if applic M is General canvnerb PJE,v �7'l y RECEIVED and Area Spot Tested suitable fc r a mound (P.O.W.T.S.) system using /o / DEC 0 1 2008 ear Bow � 7 A Cp / • S'�CROIX COUNTY # ,7 F T I [1 R 3 zONi Pit Ground surface elev. . Depth to Ii n ft factor ! in. Horizon Depth Dm*wt Color Redork Description Texture Struct Conlstence Boundary Roots G PDW in. Mu nsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 I 'Eff#2 o'-g /o yQ v 3-P • �' 2 • 5 0 .e y!o Sim- z sh rF .6 • 20 /o YR 5 ------ f shy c w o .� / C r- 5 C *2 ma-h5 dk Juh — . z • 3 5 Y7_ Y Ce soft o 3 a s� s_ 0 pit cza" d sine elev. /D 0• 1 Depth to Rd" fact" 2 in sort Application Rate Hodwn Depth Dorninard Color Redox Description Texture Structure Consistence Boundary Roots GPM In. Mu nsell Qu. Sz Cont Color Gr. Sz. Sh. •Etfifl TM 2 �O.13 /o YX y/4 L 2f,5hle dsh w i G hi 3 o Rs L / Cw — • 5 6 VA g z M O -1-5 cz - fh v ,Z - s •Effluent #1= BAD > 30 22o mglL and TSS >3o —< 150 mq& • Effluent #2 = Boo < 30 rnq L and TSS S 30 mgLL CST Name (Please Print) — 20 E2T 2lL,0 CA � ZGP.eci4l�' i - Address Date EvakuOon Cmnduoted Telephone Number r Ulbrich /V6D. l 2oag 71 S • 779 ' 3 Z �s rivate Sewage Consultants 4 2812 l ot h Ave. Spring. I t/a9@ev, W X4767 Parcel ID # �/ ' � Property Owner Z �8 # ❑ � / Page a Pit Ground suface elev. , 2 o Depth to NTOV ✓ / h / Horizon De pth Dorntnant Redox Des on Texture Str uct re Consistence Bou ndery Roots in. Munsd Qu. Si Cant Color Gr. Sr- S Sh. BW o' / /° z- 2-m S& w 3f & I .S 0 .1 S� L. l Clv s cL Sh Z Bork F] # 0 Boring ❑ Pit Ground surface elm R Depth 16 &W ft factor h SoA Rate Horizon Depth DaftiaM Color Redox Description Tech" Structure Consistence Boundary Roots GPDIIE h Mu nsell Qu. Sz Corn. Color Gr. Sz 0 4 'E1f#1 Min Boft F # ❑ ❑ Pit Ground ataface also►. R Depth to A factor . in. Shc Application Rate Horizon Depth Darinant Color Redox Description. T Structure CansMse nce Boundary Roots GPM h Muni" Qu. SL Cont. Cdor tar. Sz Sh. 'Etf#1 'EW a Borin # 0 Boft 1 Grourd elev. R Depth to factor in. Pit Soi Rate Horizon Depth Mm*wtCdm Redorc Denim. Texture Structre Catsistenoa Boundary Roofs GPM h Mu nsd Qu. SL Cont. Color or. SL Sh. *m OEM • 0 `- 34 0 3 D• z13/•3 6 •o 3 Z Property Owner Parcel l0 # Page of # ° q . -5.5,19 Pit Ground solace elev. _(� Depth to facxor ,�_ in Sod Application Rate Horiaon Depth Dominant Color Reclmc Description Team Sttuckire Cow Boundary Roots GPOW in. Munaell Qu. Sz. Cont. Color Gr. Sr- Sh. TIM 'Etf#2 0 -/0 /o �- �,�t s w 3f o•� - 2f"5 he 4 w & 14 __--, Si L l Ct v ---- c .5 Boring ❑ # ❑ Bwhv ❑ Pit Ground adage elev. I Depth b &Wft UdDr in Sod Application Rate Horizon Depth Dominant Color RBdox Description Texture Struckn Corststence Boundary Roots GPI im Mined Qu. Sz. Cont Color Gr. Sz. 'Elf#1 TIM Soft ° 9 ❑Pit _ Ground scrface elev. R' Depth to g facSor _ ' ' - in. Sod Rate Horizon Depth, Dominant Color RedcK 0e110iption. T Stuctime Consistence Boundary Roots GPOW in. MWnsd Qu. Sz. Cont Color Or. Sm Sh. •Eif#t 'Etf#2 a # ❑ Bmbv ❑ Pit G etev. ,t Depth do tirrrii�rg factor in. Sod Application Rate Horizon . Depth Dw*wtCdAr Redca Des 1ption. Texans Suucwm Consistence Borandery Roots GPDN- im Mowed Qu. Sz. , Cont. Color Gr. Sz. Sh 'E!f#1 'Etf#2 1 AIX GDT" 9 0 z s�T Top o a yEt uu-t yRO �frr,. X 0 0 .7 9 o S qg o 07, I 3 too • 3 z a � BCD 0 D o i -S. �y 5 S r eD o vcJD Comic., / OR i i i Mo G.uD S yST' / V. 7 OA,) Cv Ulbric i- , Private. Sewage Consultants / 3O E: 2812 1 0tl': Ave. SC-9l �princ °.-F, ey, Wl 1 ;4767 e = /3,4 72 0 -4D > t ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION CORM Mailing Address 3 6 D Property Address ; (Verification required Voin Planning Department for new construction) city/state � ��SoN �j /. Parcel Identification Number 0 3 / 3 /' LEGAL DESCRIP'nori Property Location it.,` y Sec. , T 30 N -R — Town of Subdivision Lot 3 � Cet-tilled SRI Map 9 , Volume _ . Page # o Warranty Deed # V 3 0 ? 5 Volume _ Page # Spec house 0 yes �10 Lot lines identifiable y es �j y o SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper mainten, consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the syi can affect the function of the septic tank as a treatment stage in the waste disposal system. The inoperty owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and t master, rtumber, journeyman plumber, testticted lumber or a lic eased . P verif ' is in proper operating condition and/or (2) a tier inspe and pumping n r g � at (1) the on -site was lewaterdisposai sys p mping (if necessary), the septic tank is less than 113 full of stud Iiwe, fire undersigned have read the above requirements and agree to maintain die private sewage disposal system with the stand: set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certificai, stating that yorir septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within days of the t ee ye r ex p' n date. SIGNATURE OF APPLICANT y . 4 ^k ; DAVE UWNEIi CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) 'dut (are) the ownet(s the probe y crt above, virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Depsttm t include with tills applicafinn: a stamped warranty deed From the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed S rc + C_ bo ov Uikricht & Associates v � � ,� � Private; Sewage Consultants �j 2812 ) 0th j'Nve. prinp ValleNi, W1 54767 II 1 } ky , . .. �\ tis g sr \ � ��• • IN N88w4lT 279.59 \ LOT 36 = b 3.002 ACRES 130,780 SO. FT. P L.B.O. =878.5 c75 = DRAINAGE = LOT 35 �= EASEMENT G = . 3.001 ACRES r i (37 130,709 SQ. FT. i H.W.L. =876.5 Vr / S87°07'07 - -=_ -- THELEN — - - - f, • /� / / H.W.L. =873.5 LOT 34 / ... ...................................... ► 3.000 ACRES 7= 130,681 SQ. FT. N 0 `DRAINAGE L.B.O. =875.5 EASEMENT F --- - - - --- `----------------------------------- 578.12 1 so 1 'Nll SENCHMARK TOP OF 1• IRON PIPE ELEVATION =874.6 ' 10 - 1 1 .� t; r - I s IIIIIIIIfRIIIIIIIIIIIIIIIRIIIIIIIIIIIIII lIIIIIIlfI 8 8 3 0 9 5 l 883495 KATHLEEN H. WALSH State Bar of Wisconsin Form 6 -2003 REGISTER OF DEEDS ST. CROIX CO., WI SPECIAL WARRANTY DEED RECEIVED FOR RECORD Documera Numixr Docurne x Name 10/20/2008 O 1:OOPM WARRANTY DEED EXEMPT I THIS DEED , made between lakelandConstruction Finance, i REC. FEE: 11.00 TRANS FEE: 186.00 ( "Grantor" whether one or more), PAGES: 1 and Kurt A. Wasieleski and Melissa J. Wasieleski , HUSBAND AND WIFE As STIEVTVORSHIP MARITAL PROPERTY ( "Grantee" whether one or more). Grantor for a valuable consideration, conveys to Grantee the following described Recording Area real estate, together with the rents, profits, fixtures and other appurtenant interests in ST CRO X County, Wisconsin ( "Property ") (if more Name and [return Address space is needed, please attach addendum): Lot 36, Plat of Settler's Glen in the Town of St. Joseph, St. Croix County, R VAT Wisconsin. Abstract Property i-000- 0 30-213►• A# 000 Parcel Identification Number (PIN) This Is Not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible, in fee simple and free and clear of encumbrances arising by, through , or under Grantor except: Restrictions, declarati covenants, reservations and easements of record, if any 0 - aft 10 /15 4 (SEAL) (SEAL) * Richard Lerew (SEAL) (SEAL) * Vice President of Lakeland Construction Finance, LLC AUTHENTICATION ACKNOWLEDGEMENT Signature(s) STATE OF MINNESOTA ) )ss• authenticated on DAKOTA COUNTY ) Personally came before me on 10/15/08 * the above named Lakeland Construction Finance, LLC TITLE: MEMBER STATE BAR OF WISCONSIN BY: RICHARD LEREW V.P. (If not, tome known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instr e t and acknow dgcd the same. TIRS INSTRUMENT DRAFTED BY: Executive Title 5100 Gamble Dr, Suite 450, St Louis Park, MN 55416 kdfarf Vublic, State oFAW4sce6sin j'1'l.iOMb-�%— My Commission (is permanent) (expires: V �1'zcl� (Signatures may be authenticated or acknowledged. Both are not NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHO Y (��n SPECIAL WARRANTY DEED C 2003 STATE BAR OF WISCONSIN �olfh'Mo.6 -2 3 Type name below si lures NOTARY PUBLIC - MINNESOTA PDF created wit l pdfFactory Pro trial version www.odffactory.com MyCommissionE)Orss Jan. 31,2010 1 of1 i C,OUMY PLAT OF: S ETTLER'S GLEN 9 r✓ THE F 41't♦'Wl4.ot LOCATED W PART OF THE NWI/4 OR THE SWV4, PART OF THE NEV4 OR THE SWV4, THE THE CONEMSEV.TION EASEMENT NOPf PART OF THE SEV4 OF THE SWI/4, PART OR THE NWI14 OF THE SEV4, THE SWI14 OF AND T HE AT E OONN ENT THYME ON THIS PLAT ARE CONVEYED THE SEV4 OF SECTION 23, AND IN PART OR TUB NBV4 OR THE NW V/ OF SECTION 26, TO THE TYMa OF ST. JOSEPH. ALL IN TJON, R20W, TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN. I OWMIL: oaAaiwtx uaEDHIeNr D ✓"°/ �.�� tN`44Tt17NMtIM.t1I 1 - - -- - z - - - - - -- `ft . ,t ,r m A SM w HMV 1 p 5 LOT 1 .. ! f BAm am \ ! ,tW I / � :' aAmA0116 ..... •. - 7mm B0. R. '........ � 4.\ f ,atAet to Pr._.� 't LOT w,. +°.° A� `t,Or IS I - � aAm ACYtts '\ tramttncr. `\lY� \ \\ I I i -' \, �' ca _- - -•- -• •-- •- -• -- �� `' Min \'°x `E,m,t ° I ,s ■ �. .' E �d: J "fir... ................... - LOT j d p ,/ Ap- ........ ..... gyp. . &M amt AOF" - \` q i H.W \� aAO1 At3tEt DN l O,tLTR (NprTO �OIILO DITAtL• AB4A4 to /O ♦ b ��� \ �,/C •\ fntriEwreAEEr LOTU DFkQNAGE \ \�� \ i MA� \ -- lagttttO.PT. \ EliiiTMr D ...♦ \: LOT 86 LOT 86 u.o..nan fL E \\ \\ r�wvi�w .:7T \ :' � taaTtn ea aHAt+Aatr LOT 86 \. . \ \ I.Y.O. —tat0 �• `d \ \ g tTaeeEr D a.m+ ApEY \ �t OURLOT 1 V \ i ` \ N� ... .Tm txi tT. i 1 ,AmAGitm ST KW 1.NraNiIt ............. ....... ..... .............................:: I a w.f. -ti g' j 9 Y ca.E7Btr i.. -. __ . __I 8 14 `_._.c.oMtnt__• / \ /i`—--------- PARM- L-- - -- tnmvrtaetrz - • -� �` .✓ \, -- - -- --- _ - YtYtz __ - TR'"` - - A, / KW.L.araA � 3 1r• ... ............................... - :I.............. LOT 18`` \ \\ ♦ t sAm MORd - \ \ \��.� \ -jy t.ODt Ap1A ♦�. \ / f i :' tanaat to n. LOT 78 \ ♦ / �. -, tmn, Na sr. '►'• \\ M I �`pWEApg Ls.Q.nt. 3AWAOd \\ ,\ \/ E ldO..WiA ........................................... ............................... ....................... ............................ ' ] J \ ♦ \.: aa4 LtatwYt)°at•tot �� M4•IT \ ,� i Lmmixasoaanm�I_.�o'+�sas si, ° �'� � } tt� er` l" S&N LAND SURVEYING INC. 1 Ig raw,t uttA„Y 7s v TIC TICln l ff ST. JOSEPH 6 I M xwooAatttttsr SOAV[t, KV FIAT M TOL liD1 M M TOJN aT..D4LM1, i�• - �� �J' oaO�N. tNe,°t, vn ecvEamisNr 1TYtArtttl trvttas n ttBa7r AMAP/f9 n ' ZZ - / .. W10101R,itrC /IH071� awvw x H� mtTtrY T1Mr M rttp[GmE6 li A CT' Ot' A !tom 4N7tlT 4 �At01�\xeot� 3 11[>aYi ALTO n M laYa /MRP Y' M T01M ? ST. ,.�VN PIHAr� PYR y / � n.Jm9H OY6-0IIQR EVE aOttR IM atuYAmw lot lq. v I tr T ff N ter "-I- w1f: „ o„m 11WM1 M tYYt A N11YtOH SMS SHEET 2OFa '°' '• °° J0°M°'tttro,AtM Wisconsin Department of Commerce SOIL EVALUATION REPORT Page or-3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County (fro Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must 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. ✓V 3 �� Please print a R . ed by Date .� ' �� Personal intomiadon you provide may be used f seoor i 04 (1) (m ))• Property Owner erty Location t me w 2 8 C. 0 u 2 . Lot 5G 1/4 5W 1 /4 S Z 7 j T 3 Q N R U E (or) Property Owner's Mailing A of # Blodc # Subd. Name or CSM# CQ C i ty State Zip Code Prione 141111111 er ❑ City [] Village B Town Nearest Road U� r MN (� I -241` S h ❑ New Construction Use: Residential / Number of bedrooms '" Code derived design flow rate � ?J Z/, d 4 GPD ❑ Replacement s- ❑ Public or commercial - Describe: Parent material i 1 Flood Plain elevation if applicable lam/ , ft• General comments Sy5�t' M - f- /eV, r - 4. $d and recommendations: elint` d v Boring # Boring _ Pit Ground surface elev. ft. Depth to limiting factor 2 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 2 S�'1 c_ I �� 14 C� 1�+ r 5 ► I 2rn�b �n - y 3 2&tccl 1 ibl - sh' up-7- y �t� S �b - I Boring # ❑ Boring pit Ground surface elev. 9 S R Depth to Limiting facto Z 4 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. 'Efr#1 •Eff#2 sr,( 2 c I'J • g �y -Z 1�t y 5i 5bk r c` — L{ 3 2 - 4 4 - 1 40 L 5I(P ` �•� /W SiLI 2m — r C Effluent #1 = BOD > 30 < 220 mg[L and TSS >30 < 150 mglL ' Effluent #2 = BOD < 30 mglL and TSS < 30 mglL CST Name (Please Print) Signature CST Number Z, 33� Address Date Evaluation Conducted Telephone Number Property Owner rri nneS Parcel tD # Page 2 of Boring #❑� B n g IQ Ground surface.elev. , l) _2 1 fl. Depth to limiting factor I Horizon Depth Dominant Color Redox Descri Lion Texture GPDSoil Application Ra P • Structure Consistence Boundary Roots /Il2 In. Munsell Qu. Si. Cont. Color ' Gr. Sz. Sh. I 'Eff #1 • •Eff #2 �r `-5 - - � F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rat Horizon Depth . Dorninanl Color Redox Description...... .Texture _Structure Consistence Boundary Roots GPD /11 In. Munsell Qtr. Sz. Cont. Color Gr. Sz. Sh. 'Eft#1 'Eff #2 Boring # ❑ Boring El Pit ' Ground surface elev. ft Depth to limiting factor in. Soil Application Rats Horizon Depth Dominant Color Redox Description Texture . Structure Consistence Boundary Roots GPD /f1 1n. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Elf #2 I ' Effluent #1 = BODS > 30 < 220 mgA- and TSS >30 < 150 mcyL • Effluent #2 = BOD < 30 myh and TSS < 30 mg /l. The Department of Commerce is an e(pral opportunity service provider and employer. If you need assistance to access services or need material in an altemate format, please contact the department at 608-266-3151 or TIT 608 -264 -8777. SM -1310 (R07100) i PAGE__3 OF 3 NAME 1-X r Y `czw — LOT# 3 Ca LEGAL DESCRIPTION 56 Y 5�/% .S 23 T 3 N. 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