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HomeMy WebLinkAbout030-2131-37-000 Wisconsin Department of Commerce Count PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division • INSPECTION REPORT Sanitary Permit No: 430188 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 Holder's Name: City Village X Township Parcel Tax No: St Joseph Development Inc St. Joseph Townshi CST BM Elev: Insp. BM Elev: BM Description: Sectionrrown /Range/Map No: 23.30.20. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark I f;,�E cse-cz \ Zso / go 0-10 CD -'N 00.00 Dosing 1 � I � � Alt. BM Aeration v7 `V (� Bldg. Sewer I Holding SVHt Inlet L f ha i 2ef 117, SVHt Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic r Dt Bottom r o $U 13 I b •aS Dosing k � < « .r I p. f Header /Ma ��� R 5.• I'D d t. Aeration Dist. Pipe 1 Holding Bot. System 3 p 2•So /1 �•9 2 3 . � ' Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand ove GPM ST- wno,�, �0;+� eh Model Number �PG •�. L(1„ �j a- o TDH Lift t Friction Loss System Head TDH Ft ' r •�5 2.0$' --- . S3 Forcemain Length,l Dia. Z rt Dist, to well r 7 SOI PTION SYSTEM R /TRENCH idth / Length No. Of renches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM S SETBACK SYSTEM TO O/ P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacur1j INFORMATION Type Of System: r f CHAMBER OR �t+r971'� • �� * ` �/ ? 100 UNIT Model Number: tr �2 DISTRIBUTION SYSTEM Header /Manifold it Distribution x H x ci ng Vent to Air Intake i QS Pipe (s) r Length Dia L Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over TBedp Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center rench Edges Topsoil Yes [] No Yes � No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: A a a Inspection #2: Location: 1432 Settlers Way Hudson, WI 54016 (NE 1/4 SW 1/4 23 T30N R20W ettler's Glen Lot 37 arcel No: 23.30.20. ,t 1.) Alt BM Description = , S�4 2.) Bldg sewer length = I� �D` mw C� mount of coyer - 2 — �� +� � 2. u .�, 2"� _ -ems! - _-.ems[ _s; - -��-� ,S J revis RequiredT de for additional information. Yes e other SBD - 6710 (R.3/97) ate J In�s�ep C S at � -t \J � V'tt'� t't.•ep)L �� 1� t�{rcn+cax o„�px y�.� Safety and Buildings Division County AN a 201 W. Washington Ave., P.O. Box 7162 GY ` VIsconsin Madison, WI 53707 - Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266.3151 L�l3 0 Sanitary Permit Application State Plan �I. J.D. Number ]n accord with Comm 83.21, Wis. Adm. Code, personal information you P rovide may be used for secondary purposes Privacy Law, sIS.04(1)(m) Project Ad ss (if different than mailing ad�hess) Y. Application Information - P t]t All lk formatlotr - - - - -- roperty Owner's Na me � 1%a_5_e1A1A ve%*,*ft e.-,- � Parcel q l _ 1 � a Block roperty Owner's Id ailing Address Property Location �o 020 6� -A. _ �k,Section o 2 City, State Zip Code Phone Number (circle one) II. Type of Building (check all that apply) T 3Q N; R aQ' E or�✓ K1 or 2 Famdy Dwelling - Number of Bedrooms �� I Subdivision Name CSM Number ❑.Public/Commercial - Describe Use ❑ State Owned - Describe Use 3 J4 13 ❑City_ ❑VillageXTownship of S�.TssY III. Type of Permit: (Check only one`hox on line A. Complete Une B if applicable) A ' New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal El Permit Revision ❑ Change of El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner I TV. Type of POWTS System: (Check all that apply) X Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil L Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter each( Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Oth (ex 1 in) V. Dispersal/Treatment Area Infor ation: 7 ", sn e 31 - Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Propose (0) System Elevation Go r✓ . /�Qo �- !a /3 3, 0a VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Asti 25 Gallons Gallons of Units �/� Concrete Constructed Glass New Existing —o kje " Tanks Tanks Septic or fielding Tank x fog. �s x°S e Aerobic Treatment Unit Dosing Chamber < L 2 r VII. Responsibility Statement- I, the undersigned, assume responsibility for WtaUation of the POWTS shown on t attache plans. Plumber's Na me (Print) Plumber's Si gnature MPRS Number Business Phone Number a, Plumber's Addre ss (Sweet, City, State, Zip Code) VII Count /De artment Use Onl 0 Approved :3 Disapproved Sanitary Permit Fee Includes Groundwater Date Issued wing A nt Signatur Stamps Surcharge Pee) � a 5 6'V ❑ Owner Given Reason for Denial IX. Conditions of Approval/Reasons for Disapproval i /° /_0 > is P -4,t 3. �3 at 57 AdSch temple (to the Coun y oul for the sy oq pyper not less than 81/2 x 11 l a SBD -639$ R. O1 /03 3 dt,�, � f 3• 0 c /p 1 0&?�! s $ o S c.�S 13M.. S3i.Q.'rr� Y ol 1 i Q o p � d a �� SEPTIC ;..NK ! y" :. i� CLSS SLCTIGN A�,D , r . T r " " , :CA , . �w�.v� I 4 Cl VENT PIPE 12" MIN. ABOVE GRADE' WEATHERPROOF ? ?S' F ROM DOOR, WINDOW OR JUNCTION BOX APPROVED AIR INTAKE WxTF CONDUIT , `tAJNFOLE COV f_'r, FyNISHEf RAI ;E W! PADLOCX & 4 L 4" " Cl RISER � ---�+� � ... WARNING LABEL. ,s :, IN. Sir MAX, WATER TIGHT SEALS GAS - + A Si.AL ` PPROV£D �PPROVEB I JOINtTS WITH! ' 3' B BALM APPROVED PIE )NTO SIL ,I D ON 3 ONTO ' SOLID SOIL c PUMP OFF £LEV . FT. 1 OFF ** RISER E, IT 1 D PERMITTED ONLY IF TANX MANUFACTJR R 3" APPROVED BEDDING N HAS AFPROVA �N U TANK CONCRETE PAD SPECIFI SE °TIC t DOSE TANK MAhnJFACT'URER : NUMBER DOSES PER DAY I'q3* SAES.. SEPTIC GAL. DOS?" iILME IIvCI�J�JING DOSE 4c� Gr�L. FLOWBACX. i GAL. ALARM MANUFACTURER: ��~,� CAPACITIES: A = �� I2vCHES MODEL NUMBER: ----_ -- -% , .. GA SWITCH TYPE; er $ = ? INCHES = _.q2_ GA.. P. MP. MANU ACISJR£R : co - �/.r' C INCHES MODEL NUMBER: ,' 6 ... l� SWITCH TYPE: e; INCHES = R�'UiREA DISCHAF.GE RATE ' ,p; PUMP E ALARM W RING AS F-ER ILHR 16.23• � °�C VERT""C,AL DIFFERENCE EE;WEEN PUMP QF F AND D'rSTRSBtJ7'ION PIP£ . r � FEET + MINIMUM NETWOR2< SUPPLY PRESSURE - F T .. FEET FEET FORCEMAIN X AFT /IJO FR CTTON FACTOR TOTAL DYNAMIC HEAD ItITERNAL D OF v ' r t�M. TA,t►r K: LE!�G1H , WIDTH ; nAT":E7'ER �^ r w 5 r G NED . ���'` ""-- ,..•�:��*' �''. i.. i C E N S ?` NC M B E R: �- n •• r . Goo • i' ns submersible Effluent Pump y EPO4' EP05 APFUCATION • Fasteners: 300 series * Fully submerged In high ■ Motor Housing: Cast iron stainless steel. = and ne oil for for efficient heat transfer, follo wing ftcai uses: designed for the • Mo of running efficient strength; and durablifty. • thout damage to heat transfer. ■ Moto Cover. Thermoplas- Effluent • Homes components. Avali.able far automatic and tic cover with integral handle • Fangs Motor: manual operation. Automatic and float switch attachment ! Heavy duty sump • EPO4 Sind phase; 0.4 HP, models include Mechanical • Water transfer 115 or 2 0 V, 60 Hz, 1550 Float Switch amambied and a Power able: Severe duty • Dawatering RPM, built in overload with preset It the fadory. rated oil and water resistant automatic reset ■ Beerings: Upper and lower • EP05 Single phase: 0.5 HP, heavy d ball bearing SPECIFICATIONS 115 V, SO Hz, 1550 RPM, FEATiIJIKS Pump; EP54 built in overload w ■ EPQ4 impeller: Thermo co on. • Solids handling capability, automatic reset. plastic Semi -open design AOY U8T1itG ale' maximum. • Power cord: 10 foot, with pump out vanes for — ... —•- • Capacities: up to 55 GPM. standard length, 16/3 SJTfO mechanical seal protection. �� rauuaefandmaaa:sardatl • Total heads: up to 24 feet. with three prong grounding fin Impeller: Thermo - • Discharge size: I NPT, plug. Optional 20 foot plastic enclosed design for (CSA listed modei numbers • Mechanical seal. carbon- length, 16/3 SJTW witf} end in r or "AC.) rotary/ceramic- stationary, three prong grounding plug improved performance. BUNA -N elastomers. ;standard on EP05). ■ Casing and Seas: Rugged • Temperature: thermoplastic design provides 104 j4K) continuous superior strength and 140•F VC) intermittent, corroslon. resistance. • Fasteners: 300 series r MRS FM stainless stall. 10 E • Capable of running dry without damage to g 30 i components, s Pump: EPOS e • Solids handling capability: 2s Ye maximum. I ' • Capacities; up to 60 GPM. a 20 • Tow heads: up to 31 feet.. • =W- 1If NPT. 5 seal: carbon. e ro /c ry eramic - stations , 4 SUNA -N elmtomers. • Temperature: 3 10 104•F (40 continuous 14VF (6K) intermittent z 5 41 0 0 0 10 20 30 40 50 GP M CAPACIV 0 11$" ftft Pumps, kra. r f o ve May, Igo r PAGE 3 OF — 3 50 LOT 3 4-- LEGAL D RIPTIONXII� XSu/ X , S Z T3 N.R. E(or)Q) SCALE: 1 "= �D — - - - - -- - - -- BM 1 ELEVATION . I I 1� O I BM 1 DESCRIPTION BM 2 ELEVATION BM 2 DESCRIPTIO Je o.f- 2 " ,}� 1 SYSTEM ELEVATION O �- � i SYSTEM TYPE Con de✓)-�o na. i CONTOUR ELEVATION 7 2.3 q 110 o q 5- N � ' a � ;° 9S a t jr SIGNATURE DATE i µv h 19A �" wn;7ep®rtment of Commerce SOIL EVALUATION REPORT Page / of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 U2 x 11 � - ° I.D. + include, but not ilmlbed to_ vertical and horizontal -eft encx (BM), percentsbpe, scale or dimensions, north arrow, and location d distance to nearest road. Date ' Z003 Please print all inibrmadon. 3 L)1_ 1 d Peraoaat information you Provide may be used for aaeondwy PwP Pmaey Law. s. 15.04 (1) (m)). Property Owner i c• I C7 M3!!'t 3o N R ZU E rs Mating Address tfbd. Name ar CSM# Property Owne U Qo �� ,ens i%r e e-- r y Sffo Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road i4v d - 3'e� I 1&1( 1 s-1 - S o --'� W New Construction Use: ED Residential ! Number of bedrooms — q Code derived design flow ram l d d -- GPD ❑ Replacement / ❑ Public or commercial - Describe: r� ( -- Flood od Plain elevation applicable Parent material General comments SYS � { wv el-r— and recommendations: Boring # D Boring Pit Ground surface elev. gS' ft. Depth to limiting factor _ D 4 *001 n Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence t�:j Roots in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Etf#2 I 0 - / 0 16-4(-311 _ L sb� t: r Z > o -z3 ai / — Z r- Cw vl a Z- f Boring # Baring Pit Ground surface elev. 9 y4 _ ft. Depth to Nmit'mg tailor S in. Sol tiorh Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1fF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Etf#1 'Eff#2 3 SL s -5 G -- o s C r.✓ - f i W1 — 11,2 5 ft— 3 &n ; • Effluent #1 - BOD > 30 < 220 ng& and TSS >30 1 150 mg1L ' Efflu&vt 02.= BOD ^ 30 mglL:and TSS < 30 mglt. CST Name (Pie fture CST Number _ Q Address Date Evaluation Conducti& Telephone Number property Owner J C)K ✓l S C ) Parcel ID # Q Page Z of _ Boring � a B °r g 'g # Ground surbw elev. ft. Depth to +g in. sod Rate Gb Pit Horizon Depth Domkwtt Cd0r Redox D Texture Struucture Consistence Boundary Roots GPD/fP in. Muusel Qu. Sz. Coat Color Gr. Sz Sh. p i3 3� — s Z i3 �- 3 ❑Boring # ❑ Boring E] Pit .Ground surface elev. ft. Depth to uniting factor in. Sol Application Rate Texture Stntu3ure Consistence Boundary Roots GPDIfg Horizon Depth Dominant Color R 3dox Description '0101 'Eff#2 in. Munsed Qu. Sz. Cont Color Gr. Sz Sh. D El Boring # Boring Ground surface elev. ft Depth to Iaruting futclor in. Rate Pit Sol ica* Horizon Depth Dominant Color Redox pescription Texture Structure Consstence Boundary Roots GPD/W in. Munsell Qu. Sz. Cant Color Gr. Sz. Sh. 'Eff#1 '002 * EMMA #1 = BOD > 30:S 220 mglL and TSS >30:S 150 rnglL ` Effluent #2 = BOD 30 mglL and TSS <_ 30 mg/L The Department of Commerce is an equal oppornmity 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 (R.0) /00) • PAGE 3 OF 3 NAME 5 k A to LOT# 3 3- LEGAL DESCRIPTION NF YSu/ 4 ,S 23 T3 ,N R Zr- E(or&) SCALE: 1"= BM I ELEVATION /00. o BM I DESCRIPTION foe v -e ow lf Qa 4 r BM 2 ELEVATION BM 2 DESCRIPTION - 1 SYSTEM ELEVATION O SYSTEM TYPE Can ✓p-,h o na L - j CONTOUR ELEVATION YZ/6 I 1-- - -- - - --- -- �� e DATE SIGNATURE �/� -� i s - c <e "0 37 CTf .v sP P4. t o � E ZUr 1 2� �alJ" � � 3 f 5,p I I api Y7, I 3 � _ Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 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 1. . percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all F f rina rain. ' ' �� �_ __ t * viewed , * Date Personal information you provide may be used for seco ary purposes (Privacy Law. s. 15.04 (1) (m)). Property Owner Proper Location Oaf( ltd Oc� 1rC ' 4ovt. of lVr— 1/4 SW 1/4 S T 3,5 N R Z Q E (or)® Property Owner's Mailing Address lot # Block # Subd. Name or GSM# 12c� ll� r '3�l - P� City State zip Code Phone Number ❑ City ❑ Village � -Town arest Road 1 I fir' N � (W51 ) 4 _�q- zy t y [� New Construction Use: [� Residential / Number of bedrooms �_ Code derived design flow rate 'IS 1� O _ GPD ❑ Replacement � ❑ Public or commercial - Describe: I Flood Plain elevation if applicable Parent material I iC/ / /4 n• General comments S Y STS rrt I e .J yq 9-0 and recommendations: 6 ❑ Boring # [] Boring 91, 1 W 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/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2 I b - 1b I 3 S 1 I 2 bk, rh L �mS rYl C ` �• Z - q" ) 'b r S) to .L `f (D �2 Boring # �n Boring pit Ground surface elev. q` ft. Depth to limiting factor 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 'Eff02 I D -II si 2n �b►� 2 I -� y 16 �S s ►o s c ZP �r l� L� :) I rn - Effluent #1 = BOD > 30 < 220 mgfL and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) S' 3nature CST Number ►� Sch ZS 3�G Address Date Evaluation Conducted Telephone Number 2 13 I Property Owner Parcel ID # Page Z o 3 715 ❑ Boring g f Boring #� E g— .. :. , Pit Ground surface elev. � R Depth to limiting factor �V� In. Horizon Depth Dominant Color Redox Description Texture Struchrre Soil Application Ra Consistence Boundary Roots GPD/il= In. Munsell Qu. Sz Cont. Color Ge. Sz. Sh. 'Eff #i • Effri2 L S C- ( - Z 3� C 2A 7• SS WL F-1 Boring # E) Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth Dondnant Color Rector Description.., Soil Applicat ion Rat Texture Structure Consistence Boundary Roots GPD /fl= In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #t 'Eff#2 Boring # ❑ Boring - ❑ Ground f pit- roun surface elev. ft. Depth to limiting factor (n. Soil Application Ralt Horizon Depth Dominant Color Redox Description Texture . Structure Consistence Boundary Roots GPD /K: in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#t 'Eft #2 ' Effluent #1 = BODs > 30 < 220 milt_ and TSS >30 < 150 mg1L ' Effluent #2 = BOD < 30 mgA and TSS < 30 m 0 /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 T'IY 608- 264 - a ccess SBM$3)0 (R07ro0) PAGE_,3 OF_.3 NAME Ca v- v- LOT# 3 LEGAL DESCRIPTION_AI� V �' t q ,S 05 T 30 N R Zd 11 E(or) SCALE: I"= (J BM I ELEVATION �20. U BM 1 DESCRIPTION BM 2 ELEVA'T'ION q S- FO mac. Z. BM 2 DESCRIPTION gyp_ - ✓_�-2 -- - - - - -- __... -- - SYSTEM ELEVATION q q s g> SYSTEM TYPE Yn 0 y ^c� CONTOUR ELEVATION J � I - _--------- -- - - —— -- - -- I ` Copy sp r 1 3T `�'`' ql' 33 SIGNA'T'URE DATE �' 3��L- W Department of Commerce SOIL EVALUATION REPORT page I of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Cro f + Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must county include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions. north arrow, and location and distance to nearest road. Please print all i ° t -- --- - -- Reviewed by Date Perso information you provide may be used for NP � T� tY a , s. 15404 (1) {m)). nal Property Owner Pr rty Location O af (v Sf;U 2 8 HO? G04- Lot AIw 1/4 Sw1 /4 S.;1 T 30 N R Zp E(or� Property Owner's M ailing Addread Lot Block # Subd. Name or CSM# City State Zip Code P one um r City Villa a Town Nearest Road (� i) 3G -Z�4 - a h 3s (� New Construction Use: [ Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material V 4 ---, V" Flood Plain elevation if applicable ft. General comments SV 5 -tt -el. cv. /o/. SZ and recommendations: Ciy\ f J r - V `e (O t -OCR Tv ` OY Boring # ❑ Boring n p�-pit Ground surface elev. l-.� ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 o -ZO 10 jr 5q m 4� c S ti- Z Zo- Lo �t 13 5L k Ay4 c s 5 9 Boring # ❑ Boring Q Ej Ground surface elev. JUG d ft. Depth to limiting factor U in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD 1ft in. Munseil Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I o -Zo 10 31 y — L 2f, �bk r c5 I j 5 -y Io /3 S>_ 2 c S -Ipb ID Sl L-0 UP - 7.5 � ')CL ,ry4r - • Effluent #1 = BOO, > 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) Signature CST Number A d h zs- 3C Address - ' Date Evaluation Conducted Telephone Number (7IS)2�� -y�o8' PAGE_OF 3 , , ' NAME LOT# 3W LEGAL DESCRIPTION y j Y -,�LoX ,5 2 -c T � ,N.R, -Z �? E(orJ* SCALE: V'= U BM I ELEVATION 10c) . CD BM I DESCRIPTION LO of 1" yc . D , j I3M 2 ELEVATION q j �J BM 2 DESCRIPTION lop c)f / DuG ®�'0� I Sec Z, 3- SYSTEM ELEVATION Al (- Sa SYSTEM TYPE rno') ACA CONTOUR ELEVATION /01 ti p_3 a �vo,aa q $M Z 6� /o u •v SIGNATURE ,r� DATE - o X X ® 878.5 i T 43 . 00 ACR 881.5 1 3. BSc . 81.7 . - -_ ........ 882.9 1 X a 120' I � - - - - -- ...-- + 1 ,- I 883.1 swv ...... .......i . ... • 37 A...::': . �I X .a.�'a 878.8 Z X :•88� X t L 38 i �� .877.1 $. s (, i 81 74.1 X 878.9 ( '.' ..� .. t 1 — — — .— X 5 ;.. ' .., O l POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity al O NA �O S Permit # Septic Tank Manufacturer O NA ° 30 2 O NA Effluent Filter Manufacturer DESIGN PARAMETERS ❑ NA Number of Bedrooms 703 A Effluent Filter Model -Q\ �© Number of Public Facility Units A Pump Tank Capacity $ 013 al E3 NA Estimated flow (average) b® al /da Pump Tank Manufacturer O NA Design flow (peak), (Estimated x 1.5) 0 elide Pump Manufacturer ❑ NA s Pump Model i�0 ❑ NA Soil Application Rate elide /ft NA Standard Influent/Effluent Quality Monthly average' Pretreatment Unit Fats, Oil & Grease (FOG) 530 mg /L 0 Sand /Gravel Filter [3 Post Filter Biochemical Oxygen Demand (BOD,) x220 mg /L ❑ NA Q Mechanical Aeration O Wetland Total Suspended Solids (TSS) 5150 mg /L O Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Coll(s) G C3 NA r Biochemical Oxygen Demand (BOD,) 530 mg /L - Gr ound (gravity) ❑ In- ounssur3zed) Total Suspended Solids (TSS) 530 mg /L �,NA ❑ Mound Fecal Coliform (geometric mean) 510 OOmI ❑ Drip - Line C3 Other: Other: O NA Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other. ❑ NA C3 NA *values typical for domestic wastewater and septic tank effluent. Other: MAINTENANCE SCHEDULE Service Event Service Frequency ❑ mon s) (Maximum 3 years) O NA Inspect condition of tank(s) At least once every: 3 ear s} Pump out contents of tank(s) When combined sludge and sobnh equals one -third (Y of tank volume Cl NA p month(s) (Maximum 3 years) O NA Inspect dispersal cells) At least once every: ear(s) u months) f] NA Clean effluent filter At least once every. year(s) ❑ month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: '�' ❑ years) O month(s) ❑ NA Flush laterals and pressure test At least once every: u earls) O monthta) p NA Other: At least once every: ❑ ear(s) ❑ NA Other: 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 cells) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page Z of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tanks) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal ceilis). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal call(s) in one large dose, overloading the cellist 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. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is property and safely abandoned in compliance with chapter 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 replacement 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 a holding tank may be installed as a last resort to replace the failed POWTS. WI A ❑ it tank nA d site ❑ 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. 00 NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name Phone `"� ( 3 ( 3 t a Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name IS ,Q { (.0 • /J</l� Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.5401, (Z) & (3), Wisconsin Administrative Code. r ST CROIX COUNTY' SEPTIC TANK MAINTENANCE AGREEMEN AND OWNERSHIP CERTIFICATION FOP.�M 0wvner/Buyer St. Joseph Develpopement Corporation Flailing Address __j_2 .5 _55 Street No Lake Elmo MN 5504 Propeny Address.? (Verification required from Planning Department for new construction) City /State Tr"wn of Z J Identification Number GAP Aft; ; rht -ti Property Location NE, �_ y Sec 23 , T - � 3 a _ N.R . 2 0 W Taw n of ._.S.t___ Subdivision Settler's Glen _ Lot ; 3 7 Certified Survey Map # _ , Volume fate # Warranty Deed # 700569 , Volume 2i l' Pa ;e Spec house t yes C no Lot lines identifiable xyes ❑Ito SYST N , Improper use and maintenaneeof your septic system could result in its premature failure to handle wastes. Pr upc- t ^,aintcaa�,x consists of pnrnp 'n out the septic tank every three years or sooner, if needed by a licensed ptunper. What you put into the syste ^t can affect the function of the septic tank as a treatment stage in the waste disposal system. M The property owner agrees to submit to St. Croix Zoning Department a certification form, sgned by uu: tedlumb i c and b; a per or a licensed pumperverifying that (1) the on -site wastewatcrdisposal asterplumber, journeyman plumber, restric is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1.3. full of dude" Lwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system still. stun.'_a set forth, herein, as set by the Departncnt of Commerce and ille Department of Nan:ral Resources, Statc of '��'iscon in t- en Ca::o> stating that your septic system has been Maintained must be completed and returned to the St. Croix Count n- days of the three year expiration date. ry Zom�.� Occ t� it }; ;. SIGN.A,TL'Rp OF APPLICANT D.-%TE OWNE FICAJT N I (we) certify t t 11 statements on this forni are true to the best of my (our) Lnowled ^� 1 ; t r; Pe am . "ncr! s i y escribe ve, b virtue e, I ;';c. e.; /� Y of a warranty deed recorded in Register of Deeds 0f, , e. S * Al APPLICANT Any information that is mis representedrnay result in the sanitary permit being revoked b� di, ? n._ ....._. ...... • 'J 2065P 5`i8 -7 ioj KATHLEEN H. WALSH Document Number TRUSTEE'S DEED ST. CROIXOCO. , W 1 HENRY J. LENTZ, as Trustee of The Henry J. Lentz Family Revocable RECEIVED FOR RECORD Trust Agreement dated May 24, 2000; and Bernice A. Lentz, wife of 12/02/2002 01:00PM Henry J. Lentz, for a valuable consideration conveys without warranty to EXEMPT ii a Minnesota corporation, Grantee, the following described real estate in St. Croix REC FEE: 13.00 TRANS FEE: 4390.60 County, State of Wisconsin: COPY FEE: CERT COPY FEE: PAGES: 2 See attached addendum. This is homestead property Recording Area Name and Return Address LAND T1TLF, INC \CD y 4 � 900 S:.. ' J 030- 2032 -50 -000; 030 - 2032 -10 -000; 030- 2032 -70 -000, 030 - 2033 -20 -000; 030- 2033 -40 -000; 030 - 2043 -10 -000 (Parcel Identification Numbers) Bernice A. Lentz, wife of Henry J. Lentz, joins in this conveyance to relinquish any homestead and marital property interests, but does not join in any of the warranties. Dated this day of �[1�dy. 2002. " "Henry J. Trust "Bernice A. Lentz AUTHENTICATION // ACKNOWLEDGMENT Signature(s) 2 Q ✓y� STATE OF WISCONSIN r rt Or' d- A ,LQ .2 ST. CROIX COUNTY {{,, Personally came before me this _ day of authen ' t is ? ?lay of n� - c+M d 2002, the above named Henry J. Lentz, as Trustee of the n /J Henry J. Lentz Family Revocable Trust, and Bernice A. 4X.Y Lentz, to me known to be the person(s) who executed the signature foregoing instrument and acknowledge the same. +'60 F type or print name TITLE: MEMBER STATE BAR OF WISCONSIN signature type or print name (If not, authorized by' 706.06, Wis. Stats.) Notary Public St. Croix County, WI THIS INSTRUMENT WAS DRAFTED BY My commission is permanent. (If not, state expiration date: Robert F. Wall ) 'Names of persons signing in any capacity should be typed or printed below their signatures. Lentz TrusteesDe edStJosephDevetopment -02 J 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 NW1 /4 OF THE SW1 /4, PART OF THE NEl /4 OF THE S W 1 /4, PART OF THE SE 1 /4 OF THE S W 1 /4, PART OF THE, N W 1 /4 OF THE SE 1 /4, AND THE SW 1/4 OF THE SE 114 ALL IN SECTION 23, AND IN PART OF THE NE 1/4 OF THE NW 1 /4 OF SECTION 26, ALL IN T30N, R20W, TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN; DESCRIBED AS FOLLOWS: BEGINNING AT THE SOUTH QUARTER CORNER OF SAID SECTION 23, THENCE S89 °59'28 "E ALONG THE SOUTH LINE OF THE SETA OF SAID SECTION 23, 1329.95 FEET TO THE EAST LINE OF SAID SW 1/4 OF THE SE 1/4; THENCE N00 °05'53 "W, ALONG LAST SAID EAST LINE AND THE EAST LINE OF THE NW1 /4 OF THE SE1 /4, 2662.66 FEET TO THE EAST -WEST QUARTER LINE OF SAID SECTION 23; THENCE S89 °57'49 "W, ALONG SAID EAST -WEST QUARTER LINE, 1103.88 FEET; THENCE S00 ° 15'03 "E, ALONG THE EAST LINE OF LOT 2 OF CERTIFIED SURVEY MAP RECORDED IN VOLUME 3, PAGE 711, AND THE SOUTHERLY EXTENSION THEREOF 541.62 FEET; THENCE S89 °44'57 "W 349.84 FEET; THENCE N00 °15'03 "W A DISTANCE OF 100.00 FEET TO THE SOUTHWEST CORNER OF SAID LOT 2; THENCE ALONG THE SOUTH LINE OF CERTIFIED SURVEY MAP RECORDED IN VOLUME 4 PAGE 944 S89 0 44'57 "W A DISTANCE OF 699.66 FEET TO THE WEST LINE OF LOT "A" OF CERTIFIED SURVEY MAP RECORDED IN VOLUME 4, PAGE 944, AT ABOVE SAID OFFICE; THENCE N00 °15'03 "W, ALONG LAST SAID WEST LINE, 445.55 FEET TO SAID EAST -WEST QUARTER LINE OF SECTION 23; THENCE S89 °57'49 "W, ALONG SAID EAST -WEST QUARTER LINE, 1107.54 FEET; THENCE S00 °17'14 "E A DISTANCE OF 304.14 FEET; THENCE N89 1'28"W A DISTANCE OF 404.95 FEET; THENCE S00° l 71 4"E A DISTANCE OF 1025.47 FEET TO THE NORTH LINE OF THAT PARCEL DESCRIBED ON DEED RECORDED IN VOLUME 562, PAGE 563; THENCEN89 °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 1 52'23 "E, ALONG LAST SAID EAST LINE 1324.16 FEET TO THE SOUTH LINE OF SAID NE 1/4 OF THE NW 1A OF SECTION 26; THENCE N89'5 5'00"E, ALONG LAST SAID SOUTH LINE, 66.08 FEET TO THE WEST LINE OF LOT 1 OF CERTIFIED SURVEY MAP RECORDED IN VOLUME 5, PAGE 1352, AT ABOVE SAID OFFICE; THENCE NO2 °52'23 "W, ALONG LAST SAID WEST LINE AND THE WEST LINE OF A PARCEL RECORDED IN VOLUME 623, PAGE 331,1325-87 FEET; THENCE N00 °15'40 "W, ALONG LAST SAID WEST LINE, AND THE WEST LINE OF LOT 1 OF CERTIFIED SURVEY MAP RECORDED IN VOLUME 2, PAGE 348, 521.61 FEET TO THE NORTH LINE OF LAST SAID LOT 1; THENCE S89 °53'49 "E, ALONG LAST SAID NORTH LINE, 894.17 FEET TO THE EAST LINE OF LAST SAID LOT 1; THENCE SO4 °28'32 "E, ALONG LAST SAID EAST LINE, 523.40 FEET TO THE SOUTH LINE OF THE SW 1/4 OF SAID SECTION 23; THENCE S89 0 53'32 "E, ALONG LAST SAID SOUTH LINE, 107.05 FEET TO THE POINT OF BEGINNING. PARCEL CONTAINS 162.778 ACRES, SUBJECT TO RIGHT -OF -WAY FOR S.T.H. 35164 AND C.T.H. "E" AND SUBJECT TO ALL OTHER EASEMENTS, RESTRICTIONS, AND COVENANTS OF RECORD. , ;.- --100' z N �, • o DRAINAGE \ \ I o r I .............. �� ...EASEMENT A► f11 m I O J f H. = W.L. 882.0 �/� v I l I C�4 N89 0 44'20 "E 361.69 N89 0 44'20 "E 129.96' W _..-- - f--- HERITAGE TRAIL - —8�- - -� - - s S89 0 44 1 20 "W 361.69' i S89 0 44'20 "W 129.96' N G —. 172.34'._ 33 33' / �r►� e M l o o f N .............. 0 I O ,��0� C? c m W W LOT 38 \ ` H.W.L. 3.002 ACRES : LOT 3 1 \\\ \ \ L.B.O. 130,780 SQ. FT. 3. D-AGRES '• \ w co ` .' 130,689 SQ. FT. ' (XXXXXX) \ DRAINAGE EASEMENT 3 �+ IN ............ ........ • 263�89' • ���� 0 9 5' 133.68' / 97.00' A9� \ 33.21' N ; ' •, \• v ` ' . . . . , , ' ' • ; N88 0 35'41 "E 279.59 . , �ww _✓� �. M aj I SCALE IN FEET 1 = 100' too 0 100 200 SHEET 1 OF 5