HomeMy WebLinkAbout030-2131-44-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Latelan Safety and Building Division St. Croix
INSPECTION REPORT rmit No:
GENERAL INFORMATION (ATTACH TO PERMIT) 556390 0
Personal information you provide may be used for secondary purposes [Privacy Law, S.15.04 (1)(m)]. ID No:
Permit Holder's Name: City Village X Township
No:
Schultz, Daniel J. St. Joseph. Town of 030-2131-44-000
CST BM Elev: Insp. BM Elev: BM Description:
~tJa n/Range/Map No:
III", M 3 ' G5T 23.30.20.1098
TAN K INFORMATION
ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION EEFH FS ELEV.
Se
ptic Z Benchmark Dosing A0a
O•~r 6 Alt. B
I ♦ / ?"7.85
Bldg. Sewer
Holding Y~. St/Ht Inlet
ka. 13,95
TANK SETBACK INFORMATION SVHt Outlet
TANK TO P/~ gE LDG. V t to Air Int R D Dt Inlet
Septic y 56 d Dt Bottom
Dosing
7 SQ Header/Man.
Aeration Dist. Pipe
Holding S. 114P 106.0
Bot. System
.5 X4
PUMP/SIPHON INFORMATION Final Grade
Manufacturer VIC 1:7 ~Q~~ L
Demand St Cover
Model Number GPM Q
TDH Lift, Friction Loss l ystem Head TDH F ~O ~~UV go '
z 29 g
Forcemain Length- Dia. it Dist. to Well AA
Z
L
SOIL ABSORPTION SYSTEM
BEDITRENCH Width Length / No. Of rench PIT DIME SIGNS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION
Type Of stem: CHAMBER OR
• J S 72 UNIT Model Number: _
jyj
DISTRIBUTION SYSTEM
Header/Manif Id 4 Distribution x Hole Size
Pipe(s) t ~j x Hole Spacing' Vep{Jto Air Intake
~ Length y'
Length_ Dia J Spacing jo Mall"
!L/✓
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only d ♦.n~,
Depth Over Depth Over xx Depth of
Bed/Trench Center / ~L[ Bed/Trench Edges \ Topsoil soil 1 1 (yr xx Seeded/Sodded xx Mulched
TT
Xes 0 No es ~l No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 5 / Z
Inspection #2:
Location: 1440 Settler's WaYIqulton, V1/I ~i082 (NE 1/4 SW 1/4 23 T30N R20W) Settler's Glen ? 44 U
F/ { In Parcel No: 23.30.20.1098
1.) Alt BM Description =
2.) Bldg sewer length 6
amount of cover = l.~ r 6
A > 4yZ dew a
Plan revision Required? ❑ Yes No -
Use other side for additional information.
SBD-6710 (R.3/97) a e Insepc s Si ture Cert. No.
y,. ~
~
~ ~
ti
.
~T .
,
y` S
r ~ ~
~a+A ' ~ ~
~ ~ P ,
/
~ ~
,M
♦ Ex,s radt e/O Pao ed n7Qwrd
97 So
i 98.sz~' ~.3.y8x 9.1.95w/8X7S`
Cc,/e.: / 4(Q~ 39 S~vo< 977o' dz dsPc~sa/ e/%~i ee(3)
-TC-Corhe Sc1,e~,L torop. `"4~~; a~i~'Cas,S~eee✓a 1.S,3
/5!S!D Se..{~/t/Sc•c'w r ~ 5yste.+~ elecl,`{~•ibC y9.sa'
.~ricc l~r~-, cc) r. Y J v a .1_2 1.a4600er 9g So'
r ~ C~mfow.'
g ~t 5~1/Se tt/e/:s 6/¢~ a~ t
cyy~yy, 5.e c. z 3, r z9~
encl.►ylar~f':Tapo?`
Ste. cmiX C'e, U-)/.
/ a3o al 3o - ycy(-az t 10 1 5 rlo P.tI.C.
-4A~_ tJ Q~~
r'o k ~
aXsL4 m }is
P~orOoserlcv,rst/Cancrt'(e 97y,1 J
w~plzcv &o_nrQ ea,,,siir • J tar
5 e. E: +e J.
~;'!><<rat S.T. outs .2."sc-~.~/o ~JC,
d~ ~ ~rce ~2q, K
•~"Sc6.. vop4c., ih ~dwf
p~aPos~
berCrcen,
WeSidenee, r-PraPoa4r,4 c.Je,il Pro osed
J` G{/Gr5
i
~ NOTE:
! Soil pit locations, elevations and site contours have been Held \
I verified for system design purposes and more accurately reflect \
actual site conditions than those reported on soil evaluation report. \ \
' .4JD~JraJC+ \
I \
1 \
\ Lo ca ~i'o-, o L \
\ Ea ~2v.renL`
/1t./"i ~ e 1 rci.l~
V
P~. 9 O'-'Y
°
,y to
d
O r y LA
~ ~ ~N tTJ
O
y y Mi
lot m
d o ~ °
~lot
~ ~ o C J
M eo o y m C ~ n C S
p F+ Vl A m fD ~ b m H m~ •O
~ ~p m 00 9 OQ R m T7 C Ry
m n ~ m M o°n A d `m+ p t eo m
32
A
~ 1 R A ~ 3..m S p 3. 7• m m m u~wi
rr H N N m C
O O ~s ~yb3~ <m 9
~ eo w y A A 'O ~ A m A -m~i
O 3 N S A f=D 3 ~ 7 m "O ~ e~D n V~
N3
_ a ;L v
y z O
m p Q eo eo S eo o ~
= W OC7 y ~ m A .
~ a
F.,..{ °m ~ m ran
d 1
o =
~C/
County
2°~`Ty« Safety and Buildings Division St. Croix
201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.)
~$p Madison, WI 53707-7162
Nt Irk..
w State Transaction Number
Srt Application 2 / (17 5a
In accordance with SPS 383.21(2), Wasiitode, submission forms for stale owned POWTSoare m tt d to Project Address (if different than mailing address)
is required prior to obtaining a sq t0~1`ermit. Note. Application
the Department of Safety and Professional Services. Personal information you provide may be used for secondary
1440 Settler's Way
u oses in accordance with the Privac Law, s. 15.04(1 (m), Slats.
1. A lication Information - Please Print All Information Parcel #
Property Owner' Name
SG~1~ 030-2131-44-000 • ~d `~Q
7er0 Chu1tZ Property Location
petty Owner's Mailing Address
AN
2 o -e- V b Govt. Lot
2$9 view Drive Phone Number NE Section 23
tty State Zip Code (circle one)
I _ y~/J W
Sire V► T► / 715 xxx-xxxx T 30 N; R 20 Eor
T of Building (check a that apply) Lo
Subdivision Name
1 or 2 Family Dwellin - Number of Bedrooms 4~ 44
# Settler's Glen
El Public/Commerct -Describe Use Na ❑ City of
Village of
CSM Number El
❑ State Owned -Describe Use
Na Ld Town of St 1osoh -
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A ❑ Other Modification to Existing System (explain)
ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only
List Previous Permit Number and Date issued
B. El Permit Renewal ❑ Permit Revision El Change of Plumber O11 wner Transfer to New 1 G n ~ ~
Before Expiration /hJ~
IV. T e of POWTS System/Component/Device: Check all that a 1
❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Pretreatment Device (explain)
❑ Holding Tank ❑ Other Dispersal Component (expla'
V. Dispersal/Treatment Area Information: tech T -100 effluent Elevation
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal t" rea Proposed (sf) S System ' at 12" above
1.0 gpd/sq.ft. ASTMC-33sand 600.00 S Ft t2 98.50' contour
600.00 Gpd d/s .ft. native soil 600.00 sq. ft. 120O q' ~
VI. Tank Info 01 Capacity in Total # of Manufacturer
Gallons Gallons Units w
Existing Tanks ~
P- U
New Tanks Y
X
,3 Septic or Holding Tank 19200 0 1,200 1 Wieser Concrete
0 800 1 Wieser Concrete X
Dosing Chamber $00
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS sholwnn ~PhRes heed ptanB iness Phone Number umber
Plumber's Name (Print) Plumber's Si---- gnuMP 227990 (715) 386-2131
William Schumaker
Plumber's Address (Street, City, State, Zip Code)
1070 cott Road, Hudson, WI 54016
VIII. oun /Department Use Only
Permit Fee Date 1 sued Issuing gent
proved El Disapproved $ = l l/ r r bL
p
❑ Owner Given Reason for Denial 6 ~i'1/✓
IX. Conditions W Approval/Reasons for Disapproval 3
1. Septic tank, effluent filter and
dispersal cell must be serviced / maintained-
as per management plan provided by plumber.
2. All setback requirements must be maintained
it r not less than S In x 11 inches in size
as per app ica a C~ ®adifi~tpmesplans for the system aud, subm to the County ou on papa
SBD-6398 (R 11/11) ~►V~w~
oEenxxn,~ Safety and Buildings
y/ Tp 141 NW BARSTOW ST FL 4TH
ozg 1P WAUKESHA WI 53188-3789
Contact Through Relay
3 - www.dsps.wi.gov/sb/
t w www,wisconsin.gov
os510'sScott Walker, Governor
Dave Ross, Secretary
October 26, 2012
CUST ID No. 227990 ATTN: POWTS Inspector
WILLIAM C SCHUMAKER ZONING OFFICE
SCHUMAKER PLUMBING ST CROIX COUNTY SPIA
1070 SCOTT RD 1101 CARMICHAEL RD
HUDSON WI 54016 HUDSON WI 54016
CONDITIONAL APPROVAL Identification Numbers
PLAN APPROVAL EXPIRES: 10/26/2014 Transaction ID No. 2165076
Site ID No. 785254
SITE: Please refer to both identification numbers,
Jerome Schultz ` above, in all correspondence with the
1440 Settlers Way I agency.
Town of Saint Joseph
St Croix County
NE1/4, SW1/4, S23, T30N, R20W
Lot: 44, Subdivision: Settler's Glen
FOR:
Description: Mound, 4 bedroom
Object Type: POWTS Component Manual Regulated Object ID No.: 1397580
Maintenance required; 600 GPD Flow rate; 24 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); Effluent Filter
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDIT4ONALLY 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 construction or installation and prior to occupancy or use:
This system is to be constructed and located in 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).
The building sewer and distribution network piping shall be of material listed in Table 384.30-3e",d 384.30-5, Wis.
Adm. Code.
In the event this soil absorption system or any of its component parts malfunctions ~Q as to ealth hazard,
the property owner must follow the contingency plan as described in the approved pT a itlg he owner
must comply with the operation, maintenance and monitoring duties as descri in ect I I I of the mound
component manual. A copy of this information must be given to the owner upo io project.
F4c
All holding/treatment tanks are to comply with SPS 384.25(7)(a). C0"i
Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is
required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions.
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.
WILLIAM C SC11t.)MAKER Page 2 10126.%2012
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. Stats.
Owner Responsibilities:
• SPS 383.52 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. SPS 383.54(1).
• SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as
required under s. SPS 383.54(4) shall be considered a human health hazard.
• SPS 383.55 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.
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.
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
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 and the POWTS management plan to the owner and
any others who are responsible for the installation, operation or maintenance of the POWTS.
Sin ly, Fee Required $ 250.00
Fee Received $ 250.00
Balance Due $ 0.00
Julia Lewis-Osborne
POWTS Reviewer 2, Integrated Services WiSMART code: 7633
(262) 397-6005, Fax: (608) 283-7481
julia.lewis@wisconsin.gov
Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety & Buildings will be
modified. Code references with prefixes starting with "Comm" will be replaced with "SPS" to recognize the
relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept. of Safety &
Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future
reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366.
MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE RECEIVED
Project Name: Schultz 4 bedroom residential mound Estimate OCT 17 2012
Owner's Name: Jerome Schultz SAFETY & BUILDINGS
Owner's Address: 28984 Lakeview Drive f (%f I Z
Siren, WI 54872
Site Address: 1440 Settler's Way
Legal Description: NE1/4 SW1/4, Sec.23, T.30.N., R.20W.
Township: St. Joseph
County: St. Croix
Subdivision Name: Settler's Glen
Lot Number: 44 Block Number: Na
• i
Parcel I.D. Number: 030-2131-44-000
Plan Transaction No.:
Page 1 Index and title
Page 2 Data entry
Page 3 Mound drawings
Page 4 Lateral and dose tank
Page 5 System maintenance specifications
Page 6 Management and contingency plan
Page 7 Pump curve and specifications
Page 8 Site Plan
Page 9 Attached soil evaluation report
Designer: Bill Schumaker License Number: 227990
Date: 10/11/12 Phone Number: 7( 15) 386-3121
Signature:
Designed Pursuant to the
v
Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01/01), and bo 'u.
SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81Td`" °+s
Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01) ;
Version 5.1 (R. 06/06) Page 1 of 9
Mound and Pressure Distribution Component Design
Design Worksheet
Site Information
(R or C) R'; Residential or Commercial Design Note: Sand fill (D) calculations assume a
400.00 Estimated Wastewater Flow (gpd) Table 83-44-3 in-situ soil treatment for
fecal coliform of 36 inches.
1.50! Peaking Factor (e.g. 1.5 = 150%)
600.00 Design Flow (gpd)
5.00Site Slope
98.50 Contour Line Elevation (ft)
24.00 Depth to Limiting Factor (in)
0.501 In-situ Soil Application Rate (gpd/ft2)
Distribution Cell Information
75.00' Dispersal Cell Length Along Contour (ft) = 8.00 Cell Width (ft)
1.001 Dispersal Cell Design Loading Rate (gpd/ft2)
1 ! Influent Wastewater Quality (1 or 2) Are the laterals the highest point
in the distribution Y
Pressure Disribution Information network? Enter Y or N
(C or E) a Center or End Manifold
2.67 Lateral Spacing (ft) If N above, enter the elevation (ft)
3 Number of Laterals of the highest point.
0.1251 Orifice Diameter (in)
2.501 Estimated Orifice Spacing (ft) = 6.67 ft2/orifice
2.00 Forcemain Diameter (in)
80.00; Forcemain Length (ft) Does the forcemain drain back? Y
92.00! Pump Tank Elevation (ft) Enter Y or N
6.50 System Head (ft) x 1.3 13.05 Forcemain Drainback (gal)
7.13 Vertical Lift (ft) 100.98 5x Void Volume (gal)
2.2 ft 114.03 Minimum Dose Volume (gal)
0.00 In-line Filter Loss (ft) 37.07 System Demand (gpm)
Total Dynamic Head (ft)
Lateral Diameter Selection Manifold Diameter Selection
in. dia. options choice in. dia. options choice
0.75 1.25 x
1.00 1.50 x x
1.25 x 2.00 x
1.50 x x 3.00
2.00 x
3.00 x
Gallons/Inch Calculator (optional)
Treatment Tank Information 800.64 Total Tank Capacity (gal)
1200.00' Septic Tank Capacity (gal) 36.00 Total Working Liquid Depth (in)
Wieser Concrete Manufacturer 22.24 gal/in (enter result in cell B49)
Dose Tank Information Effluent Filter Information
800.641 Dose Tank Capacity (gal) PolyLok Filter Manufacturer
22.24 Dose Tank Volume (gal/in) PL-525 Filter Model Number
Wieser Concrete Manufacturer
Project: Schultz 4 bedroom residential mound Estimate Page 2 of 9
Mound Plan and Cross Section Views
T
1/106 J
Observation Pipe l
K
O, 0 A
W I . I..'......
B
z
• L
Mound Component Dimensions
ft
A 8.00 ft E 16.80 in H lift ft K Efift
B 75.00 ft F 9.50 in I ft L ft
D 12.00 in G 0.50 ft J W 600.00 (ft) Dispersal Cell Area 1312.50 (ft2) Basal Area Available
8.00 (gpd/ft) Linear Loading Rate 7.50 (ft) 1/10 B Obs. Pipe Placement
Mound Cross Section View
Aggregate Dispersal Area
Finished Grade 101.29 (ft) -1
♦ H
G1
I F 100.00 (ft) Lateral
99.50 (ft) Dispersal Cell Invert
Dispersal Cell
Elevation E D
Q..
98.50 (ft) Contour Elevation
5.0 % Site Slope
Geotextile Fabric Cover
Shading Key 0 T Dispersal Cell See lateral details on
Q1 Topsoil Cap o 1.5 ft Page 4 for number, size,
Subsoil Cap 0.0 Q and spacing of laterals.
E ASTM C33 Sand 6 M F Laterals are equally
Tilled Layer y 0.5 ft Typical Lateral spaced from the
distribution cell's
Q _ Aggregate v o centerline in the
A distribution cell (AxB).
Project Schultz 4 bedroom residential mound Estimate Page 3 of 9
End Connection Lateral Layout Diagram
C.nt.r th. lat.-Is o- eh. A 6 B d-n.nston Turn-up»l bail valwr or *I oAnoutpluq
P '
AN tat.f ats tt..d.ntc al t~- x I ►iOl.s dtdlod on the bottom of 11w lat.t Al
.Q¢t ally sDae.d S
Law als (x lorc& male of PVC Sch 40 S
(p.r COMM Tabl. 84.50.5)
Forcr male COnn.ctlon Na to of doss to mand Old at any point-
Number of Laterals 3 Orifice Diameter 0.125 in
Lateral Diameter 1.50 in Orifice Spacing (X) 2.53 ft
Lateral Length (P) 73.37 ft Orifices per Lateral 30
Lateral Spacing (S) 2.67 ft Orifice Density 6.67 ft2/orifice
Lateral Flow Rate 12.36 gpm Manifold Length 5.33 ft
System Flow Rate 37.07 gpm Manifold Diameter 1.50 in
Total Dynamic Head 15.92 ft Forcemain Velocity 3.79 ft/sec
Dose Tank Information Locking cover with warning
label and locking device and
sealed watertight
Electrical as per NEC 300 and
Comm 16.28 WAC 4 in. min.
Disconnect
Tank component is properly vented F- Alternate outlet
location
Forcemain diameter
Wieser Concrete Manufacturer 2 in.
Ca acit 800.64 Gallons
Volume 22.24 gal/inch A
Weep hole or anti-
Dimension Inches Gallons B siphon device
A 18.37 408.61
B 2.00 44.48 C P= ump off elevation (ft)
C 5.13 114.03 92.88
D 10.50! 233.52 D
Total 36.00 800.64
IF Do♦ se tank elevation (ft)
3" Bedding un er tank. 92.00
Alarm Manuafacturer SJ Rhombus
Alarm Model Number SJE 1011421
Pump Manufacturer Goulds
Pump Model Number WE05H
Pump Must Deliver 37.07 gpm at 15.92 ftTDH
Project: Schultz 4 bedroom residential mound Estimate Page 4 of 9
Mound System Maintenance and Operation Specifications
Service Provider's Name Bill Schumaker Phone (715) 386 3121
POWTS Regulator's Name St. Croix County Zoning Dep't. Phone', (715) 386-4680!
System Flow and Load Parameters
Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in
Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L
Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L
Soil Absorption Component Size 600 ft2 Maximum FOG 30 mg/L
Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL
Service Frequency
Septic and Pump Tank Inspect and/or service once eve 3 ears
Effluent Filter Should inspect and clean at least once eve 3 ears
Pump and Controls Test once eve 3 ears
Alarm Should test monthly
Pressure System Laterals should be flushed and pressure tested eve 1.5 ears
Mound Inspect for ponding and seepage once every 3 years
Miscellaneous Construction and Materials Standards
1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap,
and are secured in as shown in the mound component manual.
2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code.
3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code.
4. Tillage of the basal area is accomplished with a mold board or chisel plow.
5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion
and help reduce frost penetration.
Lateral Turn-up Detail
Finished •
Grade
6-8" Diameter Lawn Threaded Cleanout
Sprinkler Valve Box Plug or Ball Valve
Distribution
Long
47Sweep 90 or Two
45 Degree Bends Same
Diameter as Lateral
Project: Schultz 4 bedroom residential mound Estimate Page 5 of 9
Mound System Management Plan
Pursuant to Comm 83.54, Wis. Adm. Code
General
This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component
manuals [SBD-10691-P (N.01/01), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N.
01/01)) 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.
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 retain solids 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 to 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 shall be approved for septic tank use by the Department of Commerce.
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 as protection from freezing.
Influent quality into the mound system may not exceed 220 mg/L BOD5, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30
mg/L BODS, 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mL for highly treated effluent. 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 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring.
Continnencv 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(s) 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 absorption and dispersal
media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition.
See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider.
Pretreatment Units
The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection
units are attached as separate documents and are considered part of the overall management plan for this system.
Project: Page 6 of 9
f~o].GOULDS PUMPS Submersible
Effluent Pump
EP04
3871 EP05
APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- 0 Bearings: Upper and lower
grade turbine oil for tic enclosed design for heavy duty ball bearing
Specifically designed for the lubrication and efficient improved performance. construction.
following uses:
• Effluent systems heat transfer. ■ Casing and Base: Rugged
thermoplastic design provides AGENCY LISTING
• Homes Available for automatic and
• Farms manual operation. Auto- superior strength and corrosion
SP Canadian Standards Association
resistance,
• Heavy duty sump matic models include
• dater transfer Mechanical Float Switch ■ Motor Housing: Cast Iron
Goulds Pumps Is ISO 9001 Registered.
Dewatering assembled and preset at the for efficient heat transfer,
ffactory. strength, and durability.
SPECIFICATIONS ■ Motor' Cover: Thermoplastic
FEATURES cover with integral handle and
• Solids handling capability: float switch attachment points.
maximum. ■ EP04 Impeller: Thermoplas ,
• r Power Cable: Severe duty
Capacities: up to 60 GPM. tic Semi-open design with rated oil and water resistant.
• Total heads: up to 31 feet. pump out vanes for mechanical
• Discharge size: 1'/z" NPT, seal protection.
• Mechanical seal: carbon-
rotary/ceramic-stationary,
BUNA-N elastomers.
• Temperature:
104-F (40-C) continuous
140 F 160 C) intermittent. METERS FEET
10 -
• Fasteners: 300 series r
stainless steel 9
• Capable of running
dry witho;It damage to s 2s FT
components. 25
Q 7r
Motor: = Ir
• EP04 Single phase: 0.4 HP, 6 20
115 or 230 V, 60 Hz, 1550 1S 1'2
PP.1, built in overload with } 15
o -
automatic reset. ~ 4
• EP05 Single phase: 0.5 HP, o EPOS
115 V or 230V, 60 Hz, 1550 3 10
RPM, built in overload with EP04
automatic reset. 2
• Power cord: 10 foot 5
standard length, 16/3 1
SJTOW with three prong
grounding plug. Optional 20 0L 00 10 20 30 40 50 GPM
toot length, 16/3 SJTW with
three prong grounding plug
(standard on EP05). 0 2 4 6 s 10 12 m' h
CAPACITY 3r079.po•ini'r►tu••,
UU Goulds Pumps
2o02Goulds Pumps <,& ITT industries
Effective Septemoer, 2002 7 O
b3n71 / T
1
e Valkato,? lo,;&
v75~~ z3.y8'x 9,t.9S~/8x75'
~ 98so'
♦~7.Jo' e.~to~..i gz ds~~,sa/Ce/l.'~•e~(s~
ail- X 73.3 7 y8
SXStSe, 4 , i~ c
~
0 ne SC~,t.~.l~zlorop Q, or -.5 YS n ¢lC~~ lx 9950•
t 41~ .I~2 `abcuW9~SO'
v
ecm6oUr:
Lit ~~Sa-tt~e~~ 6/¢n 33 t
4cyy.sWyy Sec. Z7: 2-9,y
/1. 7Uc.9,I Tic. SE•T- 'e Z' \ M'r :Tgpof
Ste. Croix ee y cJ/, •~j 1 5 Flo P.J.C..
030 -2-! 3o - 41V -4W s9, si Elcv` = JOD. cz7'
~kr- - t Q~~
P"0100se'lw:(54-(4 cr-- 97y4 X131
wj~.PI za%co-PtQ ~h►,Sv:r i,, , 1
6e- E:
a/yleK P,4 -S1SeFf/aunt ~ ~ r
f.eio.6 .65.7r. out/ Adc•
(rce ntaia
~ "~c.~. Slop, ✓.c.. ~ n $ a wE
o F S.T.~,4
proPa~
~ seacr~n,
We5,denC2 ~--ProPoscd weAl Proposed
e> 10 C446 t~Iv¢u~ `J G{ erS
1 1
NOTE: \
1 Soil pit locations, elevations and site contours have been field \
verified for system design purposes and more accurately reflect \
actual site conditions than those reported on soil evaluation report. \
1
'4i0~~c1a'w,tx6c \
Lo Ca o f
\
\
\ \ Ea ~av»ehL
HN'~ v e 7a%/
v
p~ go r"
Wiscdnsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must - Cro
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. t4,36--,--2131 -6~u
Please print all in otTnao ° Revi Date
Personal information you provide may be used for sea ary purposes (Privacy Law, s. 15. (1) (m)).,
Property Owner e j } Prop" Location
s I, Z 20,J Govtji-ot j1 1/4,} 1/4 SL7j T a N R 2-0 E (or)(:CO
~-Mme
Property Owner's Mailing Ad ssC L Lot Block # Subd. Name or CSM#
kw
(120 T-T
City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road
41
u~ar Mcv Jb Z (cosi ) 43q-2'4 5 JoS~e h s
New Construction Use- ® Residential / Number of bedrooms _ Code derived design flow rate y5-0 Z!~ CJ GPD
0 Replacement ❑ Public or commercial - Describe: ~I
Parent material i I Flood Plain elevation if applicable ti / r t- ff•
General comments S Y 54 end
and recommendations:
0ca✓\,6Jr e(-eV, $`~v
Boring # ❑ Boring 0 r7 p
® pit Ground surface elev. 0 ft Depth to limiting factor L b in. Soii Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
1 0-12 16'a-3)5 2 ►~--r --5 I v . 5
Z 12-Z3 lb `t 4 1_ Zrrtbk c '5 '9
~-22151 CL Zrr-n~*- (P
Boring # ❑ Boring
pit Ground surface elev. q > ft. Depth to limiting factor 24 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2
1 0- Z 10 1.3 S; C Z-Y ' rn~r S v'Q
3 zco 40 r~/~ c2 7. ~f l~ Sri 2k -
• Effluent #1 = GODS > 30 < 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signa a CST Number
Adary-l 5Lku rv a er - 3369
Address Date Evaluation Conducted Telephone Number
2113 gaTti . San,~r~~~ 7- 406' '
Property Owner _ 1-164v t~brn--,S Parcel ID Page a 'ot~
F-31 Boring # ❑ Boring a
: 0--Pit Ground surface. elev. R Depth to limiting factor in.
Hodzon Soil Application fla
Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ilI
In. Munsell Qu. Sz. ConL Color Gr. Sz. Sh. 'Efft31
1 'EffH'1
o-t r 3 srl 2mo~b~ c I v-~ ~ 5
2 2q 4 .9
S
JS eq M:
F-1 Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to flmiting factor in.
Soil Application Rai
Horizon Depth Dominant Color Redox Description.., Texture Structure Consistence Boundary Roots GPD/fit
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff111 'Effli2
Boring # ❑ Boring
❑ piC' Ground surface elev. ft Depth to Gmifing factor In.
Soil Application Ralf
Horizon Depth Dominant Color Redox Description Texture . Structure Consistence Boundary Roots GPD/ftz
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Effgt •Effii2
' Effluent #1 = BODS > 30 < 220 mg4- and TSS >30 < 150 mg/t • Effluent #2 = BODS < 30 mg/l4 and TSS < 30 mg/I.
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.
sebaro (R.07=)
3
Property Owner & vParcel ID #
~Ij g Page of
❑ Borin
Boring # ; .
I I &Pit Ground surface. elev. 6Q ® ft Depth to IimlUng factor Z` I In.
Horizon Soil Appliption Ra
Depth Dominant Color Redox Description Texture Structure Consistence Boundary
Roots GPD/(l=
In. Munsell (Qu. Sz Cont. Color .
Gr. Sz. Sh. 'Eff111 •Eff!!2
2 1 ~ -I ! r 3 Sid! 2 IL sy~ C V . J
webL
2poahk 4
F 7] Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Horizon De th Soil Application Rai
p Dominant Color Redax DesuipUon....., Texture Boundary Roots GPD1112
Structure Consistence
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Boring # ❑ Boring
❑ Pit Ground surface elev. ft Depth to limiting factor in.
Rat
Horizon Depth Dominant Color Redox Description Soil Application
Texture . Structure Consistence Boundary Roots GPD/W
In. Munsell Ou, Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
, i
- ' Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 m
_ gM 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•
M-11330 (R07100)
r
PAGE,-2-5 OF~
NAME ~a (r,cecLOT# LEGAL DESCRIPTIONN/- ~s~~ S Z~ Tea N R E(or
SCALE: I"=
~U
BM I ELEVATION /00 °
BM I DESCRIPTION Jn D0 Jo- P 'D e
BM 2 ELEVATION J~ SO ~C`-L _
BM 2 DESCRIPTION4n p d .oJc- - -
i
SYSTEM ELEVATION
pa ~
d- -
SYSTEM TYPE im 00-A
C NTOUR ELEVATION ~ y
g~
~a
A
0 0 ~ G
b
s
i
ti
I
I
IGNATURE DATE - G
owp~
Lam" 45
• • 3.001 ACnES a
.OFF
• • • . , , 130.741 SO. FT. ;
100,
•
• 1.OT 44
OT 3.001 s f~►
130,710 M FT.
101 AC
,734 80. Fr.
L.e.o.:884.0
' NO
z
#
DRAJNAGE
• . EAmmEw A \4
'r •.+•.r.....••.• •
.
oo~~ ~~..yy J
C { N89" 44 381.W 1 W442ZCM 199.
_ --`HERIT`AIME TRAIL- . _ rt ~ ~
44'20W ~w.W 4 1 tOW442O W 129.9f ~
JF 'I'M M
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
NUiling Address
Property .Address .-__/Y Y~.
(Veriheationt required fromPlanuning &~artnnent for new onstxuction.
4:',itylState Q4D Q om' I Marcel Identification Number
LEGAL DE§CRI TlON
Property Location V,611 , 5'GJ V4 , Sec. _9S , T ~N R.. W, Town of
Subdivision 3--e Lot
C,ertiiied Survey Map # , Volume , Page
"Warranty Deed # Volume Page # Spec house yes no Lot lutes identifiable yes no
SYSTE NTENANCEND, WNEACE IIF C,~~ATIUN
Improper use and mam(mance of your septic system. could result in its premature failure to handle waste's. Proper
trwintenance consists of pumping out the septic tank every thrcc ,yoars or sooner,, if needed, by a licensed pumper. What you put into
the system. can affect the function of tho septic tank as a troatowat stage in the waste disposal system. Owner maintenance
responsibilities are speeifled in. 6Conini. 91. 52(1) and in Chapter 12 - St, Croix County Sanitary Ordinance,
The property owner agrrees to submit to St. Croix County Planning & Zoning Deparanent a ce3rtiftc4tion form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank, is
loss than 113 full of sludge.
I/we, the undersigned have road the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resourcros, State of Wisconsin.
Certification stating that your septic system has been mairntai tied mast he completed and returned to the St. Croix County Plannin¢ &
Zoning Department within 30 days of the three year expiration date,
Ilwe certify that all statements on this foam are nue to the best of my/our knowledge, l/we anAre the owiier(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms
` N~SI _ X
GNATU_RE OF PL_. T{S) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & zon1,:i$ Department.
Include with ,.his application a rec..orded warranty deed from the Register of Deeds tatt"ice and a copy of die ceTCitied survey map if
reference is made in the warranty deed,
(RFV. 48/OS)
II ( IIIIIIIIIIIIIIII~IIIII) III
I
8101670
Tx:4079641
State Bar of Wisconsin Form 1-2003
WARRANTY DEED 966476
BETH PABST
Document Number Document Name REGISTER OF DEEDS
ST. CROIX CO., WI
THIS DEED, made between 'j 0 -7 C 10/31/20 4:08 PM
EXEMPT 8
("Grantor," whether one or more), REC FEE: 30.00
and anin. T. 5r.hL) j }-r PAGES: 1
("Grantee," whether one or more).
Grantor, for a valuable consideration, conveys to Grantee the following described real
estate, together with the rents, profits, fixtures and other appurtenant interests, in
} . (,r 1 o x County, State of Wisconsin ("Property") (if more space is Reocrding Area
needed, please attach addendum): Name and Return Address
11 lDcn%0.l S Scti~ (fz
I, o l,ecs Clef 5-6 moltoc (roop
C rC) I x Co(-, n~~ Isom, m.u 56-0 ` 6
030-9(31-V4-000
Parcel Identification Number (PIN)
This 15 rl c, T 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 except:
=Datedlol 1-3 Z
Z (SEAL) (SEAL)
L 6c ;
(SEAL) (SEAL)
AUTHENTICATION `6ANS 11 ACKNOWLEDGMENT
Signature(s) "4.TATE OF WISCONSIN )
authenticated on Z _ dro COUNTY )
•CO
-
~G O ~sonally came before me on _ ~3e above-named f PTA r e v~GN P fz
TITLE: MEMBER STATE BAR OF
(If not, ~ttti.H~jL to me kno to be the person(s) ho executed the foregoing
authorized by Wis. Stat. § 706.06) ins=ure acknowl ed the s e.
THIS INSTRUMENT DRAFTED BY:
Notary Public, State of Wisconsin
My Commission (is permanent) (expires: io~"~g ZQ~ )
(Signatures may be authenticated or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED ® 2003 SPATE BAR OF WISCONSIN FORM NO. 1-2003
1 •&jpe name below signatures.
commerce.wi.gov Safety and Buildings Division County
A
201 W. Washington Ave., P.O. Box 7162 51r, CR pr
i sea n s i n Madison, WI 5 3 707-7 1 62 Sanitary Permit Number (to be filled in by Co.)
Department of Commerce f. -51:52-37
Sanitary Permit Applicatio State Transaction Number/ l~
aq*
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental 7'/ 6
unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Address (if different than mailing address)
submitted to the Department of Commerce. Personal information you provide may be used for secondary ~G it l~
purposes in accordance with the Privacy Law, s. 15.04(l
m), Stats. ~T7
1. Application Information - Please Print All Informa . CJ LJ
Property Owner's Name Parcel # d1/
Property Owner's Mailing Address Property Location
g
_ fl k/ IOff h~ / r~ .:t-.. ( 1 t, ST. GRuix COUNTY Govt. Lot G ♦ 1617
City, State Zip
Cod
f E M AI ~ f VC b~~- 40~- abs► ~ ( Section
eQf- circle one
II. Type of Building (check all that apply) e Lon44 T ~D N; R -:0 E ot~
VI or 2 Family Dwelling - Number of Bedrooms OVA Subdivision Name
Bloc >fs Pee
❑ Public/Commercial -Describe Use / i
❑ City of
❑ State Owned - Describe Use CSM Number llage of
4 k own ofaol ep
III. Type of Permit: (Check only one box on line A. omplet lin B if a lie bit)/
A. V New System
El Rep] ment S tem Treatme UHoI in Tan Vaj (ent Only El Other Modification to Existing System (explain)
B. List Previous Permit Number and Date Issued
El Permit Renewal Permit Revision Change of umber ❑ rmi ransfer to New ~
Before Expiration \ I I/ \ Ow er
IV. Type of POWTS S stem om on nt/Device: eck all tha I Q A QU I
❑ Non-Pressurized In-Ground P/OSMI ized In-Ground At-Grade ❑ Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispe sal ponen t (explai El Pretreatment Device (explain) /
V. Dispersal/Treatment Area ormation: a ,
Design Flow (gpd) Design Soil Application R pdsf) Dispersal Area Required (~t~ Dispersal Area Propo d (so System Elevation
~ 60 1200 1,200 94,$0 FT-
VI. Tank Info Ca ity in Total # of Manufacturer
allons Gallons Units
w~Z Io.Q loo D
New Tanks Existing Tanks
we 1'5 ef^ FI' I~ a U
Septic or Holding Tank W 125 '
7 170 l i~ve
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number
alfgQ %rb nt 7 90lba0M)' 7rs-~~ S 8
Plumber's Address (Street, City, State, Zip Code) I1P 3131111
V 7053 60VKT 5 I Lvr r
VIII. Count /De artment Use Only
Approved Disapproved Permit Fee Date Issued Issuin gent Signatu
iven Reason for Den' 1 (QL~J • CC ! .1 14
IX. Conditi WWE easons for Disapproval
)MM90 3) QO,~ 1A~~c Pr 0;~.IZ.. ne.,v
1. Septic tank, effluent filter and
dispersal cell must all be services / maintained IAAA^,Q- owwe.Ac_ 6J1 S tM°" nc~~
as per management plan provided by plumber. 4 ti `~'b1'.Kal~o~ l
3. All sehmk requirements must be maintained
as Pit
Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2x 11 inches i size
Lo.~.~~ 4"io~ S,[d~aJc•, i~ fo,k.Q a~~
1 ~C' j ~w~ II ernes t
1 4001-
SBD-6398 (R. 02/09) Valid thru 02/11
Safety and Buildings
PO BOX 7162
commerceml.gov MADISON WI 53707-7162
Contact Through Relay
sco n s i n www.commerce.wi.gov/sb/
www.wisconsin.gov
Department of Commerce
Jim Doyle, Governor
Richard J. Leinenkugel, Secretary
March 24, 2010
CUST ID No. 921620 A7TN: POWTS Inspector
BARRY BIGAOUETTE ZONING OFFICE
PIERCE PLUMBING INC ST CROIX COUNTY SPIA
N7053 CTY RD BB 1101 CARMICHAEL RD
SPRING VALLEY WI 54767 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 03/24/2012 Identification Numbers
Transaction ID No. 1779643
SITE: Site ID No. 755358
Southwind Builders - Dwelling Please refer to both identification numbers,
1440 Settlers Way above, in all correspondence with the agency.
Town of Saint Joseph, 54082
St Croix County
NE1/4, SW1/4, S23, T30N, R20W
Lot: 44, Subdivision: Settler's Glen
FOR:
Description: Mound
Object Type: POWTS Component Manual Regulated Object ID No.: 1260524
Maintenance required; 600 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System(s):
Mound Component Manual - Version 2.0, SBD-10691-P (N.01101), Pressure Distribution Component Manual - Version
2.0, SBD-10706-P (N.01/O1); Effluent Filter
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.
Cri
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06,
f
stats. is I
DF
A copy of the approved plans, specifications and this letter shall be on-site during construction and open to Df~15i
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
t= t Cc
construction/installation/operation. i_
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
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.
BARRY BIGAOUETTE Page 2 3/24/2010
As of today's date, a refund in the amount listed in the FEE portion of this letter has been initiated and
forwarded to a manager for review. The refund will be made under separate cover. Please expect a 6-8
week time period for fiscal processing. Refunds will be made to the payer.
Sinc a Fee Required $ 250.00
Fee Received $ 450.00
Refund Amt $ 200.00
Peter E PaggPlaneviewer, Private SewIntegrated 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, Monday, 7:00 A.M. To 3:30 P.M.
Notice: Starting July 1, 2009, no person or entity may engage or offer to engage in construction business in
Wisconsin unless they hold a Building Contractor Registration, or equivalent, issued by the Safety and Buildings
Division of the Wisconsin Department of Commerce.
"Construction business" means a trade that installs, alters or repairs any building element, component,
material or device that is regulated under the commercial building code, chs. Comm 60 to 66, the uniform
dwelling code, chs. Comm 20 to 25, the electrical code, ch. Comm 16, the plumbing code, chs. Comm 81 to
87, or the public swimming pools and water attractions code, ch. Comm 90. The term does not include the
delivery of building supplies or materials, or the manufacture of a building product not on the building
site.
For further information, go to our website: www.commerce.wi.Qov/SB/SB-BuildingContractorProgram,html
Note: Effective March 29, 2010, we are consolidating our Shawano full-service office with our Green Bay office.
Please address all plans, correspondence, mail, etc. related to previous Shawano services, for delivery after that date,
to: Division of Safety & Buildings, 2331 San Luis Place, Green Bay, WI 54304. If calling moved Shawano staff
after that date, call (920)492-5601.
Mound System Cover Page pg 1 of 6
QAD Z ~r
Project Name: Settler's Glen Lot 44 Mound System
Owner's Name ~ayh,,WrAtb 'I
"RU
Owners Address 1440 Settler's Way
Hudson, W 154016
Legal Description NE V '/4, SW v '/4 Sec 23 T 30 N, R 20 W
Township St. Joseph
County Saint Croix
Subdivision Settler's Glen
Lot# 44
ParcelID# 030-2131-44-000
Table of Contents
p9-
1 Cover page
2 Mound Sizing Calculations
3 Pressure Distribution Layout and Dynamics
4 Dose Tank
5 Management and Contingency Plan
6 Plot Map / Calculations
-Gay
total # of pages: 6 cTy 011,
0
°~Nc
s
Design MP/Le er Name: Barry B nse 921620PM uette J~O~UEN
Date: 3/16/2010
Ph. 715.778.5889
Signature:
Mound System Design Methods Used
per "Mound Component Manual For Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD-10691-P (N.01/01)
per " Pressure Distribution Component manual for Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD-10706-P (N 01/01)
Spreadsheet provided by: 3bAdvisement N12486 220th St, Boyceville, WI 54725 Ph: 715-643-6068 email: 3ba@3badvisement.com
Mound System P~ 2 of s
Mound Sizing Calculations
Project Name: Settler's Glen Lot 44 Mound System
Site Conditions Design of Entire Fill
Project Type: i or 2 Family Dwelling Cell depth at upsiope edge (D): 12.0 in.
% Slope: 2 % Cell depth at downslope edge (E): 14.0 in.
# of Bedrooms: 4 Distribution cell depth (F): 9.5 in.
Depth to limiting factor. 24 in. Cover thickness over edge (G): 6 in.
Absorbtion rate of fill material: 1 gal/ft2/day Cover thickness over center (H): 12 in.
Absorbtion rate of in-situ soil: 0.5 ga a/day End slope width (K): 8.7 ft.
Effluent quality #1 Fill length (L): 92.4 ft.
Max BOD effluent value: 220 mg/I Upslope width (J): 6.5 ft.
Max TSS effluent value: 150 mg/I Downslope width (Toe) (1): 8.0 ft.
Fill Width (W): 22.5 ft.
Design of the Distribution Cell Basal Area
System Design Flow: 600.0 gal/day Basal area required: 1200 ft2
Distribution cell width( l-- 8.00 ft Basal area available: 1200 ft2
Distribution cell length iff): 75.0 ft
Area of Distribution Cell: 600.0 fe Observation Pipes
Contour Elevation of Mound: 98.80 ft Location from end of cell (Z): 12.5 ft
System Elevation of Mound: 99.80 ft
Final Grade of Mound: 101.59 ft
Mound Plan View
Observation Pipes
11 Z----I
W K~ otl~-Z Distribution Cell A
I B ILK
I Tilled ArealFill Material
L '
Mound Cross Section
Final Grade Observation Pipe
Synthetic Fabric H G
Distribution Cell
System Elevation bn ,4 a Oa.~ p
. d' 1
Cover Material Lateral 3
Fill Material Invert
Tilled Area
SlopeForcemain System
Contour
Notes:
Fill material to consist of ASTM C33 Sand
Distribution cell aggregate to comply with Comm 84.30(6)(1)
Synthetic Fabric covering on cell per Comm 84.30(6)(g)
Distribution Cell to have minimum 6" aggregate below lateral and 2" above.
Mound System Page 3 of s
Pressure Distribution Calculations
Project Name: Settler's Glen Lot 44 Mound System
Lateral Layout Lateral/Manifold Design
Lateral elevation: 100.3 ft Lateral diameter: 1Y, In.
Rows of Laterals: 2 Lateral spacing (S): ft
Manifold type: Center Lateral to cell edge: 2 ft
Orifice diameter: 0.125 In. Lateral discharge rate: 7.83 gpm
# of Laterals: 4 System discharge rate: 31.31 gpm
Distal Pressure: 5 ft Manifold diameter: 11/2 In.
Lateral Length: 37 ft Manifold length: 4 ft
Orifice Spacing/Distribution Forcemain Friction Loss
Orifice spacing (X): 24.00 Inches Forcemain length: 50 ft
Orifices per lateral: 1 g Forcemain diameter: 2 In.
Avg. ft2/Orifice: 7.89 ft2 Friction loss in forcemain: 1.049 ft
Lateral Side View
Manifold
Lateral Lateral
(~77_
x x
?r x x ?r x 71' x x x x 7r x x x
2 2
Lateral Length Lateral Length
Lateral Plan View
Lateral Length Turn-up w/ball valve or cleanout plug
0 0T
S
o n~
Orifices on bottom of
lateral equally spaced PVC laterals and Forcemain to comply with
specifications per Comm 84.30[2j(e)
Forcemain connection via tee or cross to manifold at any point
Clean Out Detail Observation Pipes
Clean-out plug
Final Grade or ball valve
Water tight cap
or plug
Lawn
Sprinkler
Box
Slot
Note: Closet Collar
may be used in
6" Minimum
Long Sweep 90 I place of 3/8" bar
or two 45's L 3/8" Bar
Lateral
Mound System Page a or s
Septic, Pump and Dose Tank
Project: Settler's Glen Lot 44 Mound System
Tank Information Dosage Volume
Pump tank manufacturer: Wieser Concrete Forcemain drains back to tank? QQ Yes O No
Pump tank size/model: W1250/750-MR n Lateral void volume: 15.6 gal
Pump tank gal/inch: 16.12 Dosage to absorbtion Cell: 78.2 gal
Actual Pump Tank Volume: 758 gal Forcemain volume: 8.7 gal
Tank bottom elevation (inside): 90 ft Total dosage: 86.9 gal
Septic tank size/model: W1250/750-MR
Pump and Filter Total Dynamic Head
Pump Manufacturer: Little Giant Are laterals highest point? y
Pump Model: 9EH if not, enter highest elevation: 0 ft
Effluent Filter: Zabel A100 System head (distal x 1.3) 6.50 ft
Vertical Lift ("D" to lateral) 9.30 ft
Note: Access opening of sufficient size to be provided to allow
removal of filter. Opening to terminate at or above grade. Friction loss in fOCCemaln: 1.05 ft
Pressure loss from filter: ft
Total dynamic head (TDH): 16.85 ft
Pump Tank Diagram Dose Tank Levels
Watertight Locking Cover In. Gal
4 Inch With Warning Label
Minimum Finished A Reserve 27.6 445.4
Grade
7 B Pump off to Alarm 2.0 32.2
Alternate z- Total Dosage 5.4 86.9
Outlet
Location Elect. per Comm D Effluent depth for pump 12.0 193.4
orcem n 16.28 and Total Capacity: 47.0 758.0
NEC 300
Weep Hole A
or Anti-
Siphon B lz~ Device FLOW- LITERS/HOUR
C 0 1000 2000 3000
D 30 10
Vl
1W1 7.5 W
20 W
z
I
q 5 1
w a
Pump must be capable of: 31.3 GPM = to
2.s
and head pressure of: 16.9 Feet
0 0
0 20 40 60 80
Little Giant FLOW- GALLONS/MINUTE
9EH PUMP PERFORMANCE CURVE
115V 60HZ
Mound System Management Plan pursuant to comm 83.54 W. A. C. page 5 of 6
Owner's Responsibility:
The component owner is responsible for the operation and maintenance of the component. The county,
department or POWTS service contractor may make periodic inspections of the components, checking for
surface discharge, treated effluent levels, etc. The owner or owner's agent is required to submit necessary
maintenance reports to the appropriate jurisdiction and/or the department.
Septic Tank:
Septic tank(s) are to be inspected routinely and maintained by department approved individuals when
necessary in accordance with their approvals. The use of chemical/biological "treatments" is not required or
recommended. If such additives are used, make sure they are approved by Department of Commerce,
Safety and Buildings Div.. Effluent filters are to be removed & cleaned as necessary, with provisions to keep
solids from passing the septic during removal. No more than 1/3 of the usable tank volume may be occupied
by sludge/scum. 3 year inspection: If tank has greater than 1/3 volume sludge, tank contents must be
emptied and disposed of in accordance with NR 113 Wisconsin Administrative Code by an approved
individual. If the inspector does not recommend pumping of the septic tank, then the owner must be notified
of when pumping should be done as to not exceed 1/3 sludge volume. Septic tank should be routinely
inspected to be watertight and of good repair.
Pump/Dose Tank
If an effluent filter has been installed in the pump/dose tank, it must be removed & cleaned as
necessary, with provisions to keep solids from passing to the mound component during removal.
The pump, float switches and alarms must be inspected at least every three years for proper
operation. Pump/dose tank should be routinely inspected to be watertight and of good repair.
Mound and Lateral System
The mound system component must remain free of ponded surface water prior to pump operation. If 4
inches or more water level is detected in the observation pipes, the owner must be notified of possible
problems/failure. The designed daily flow capabilities of the component should never be exceeded. Trees
and any other deep rooted vegetation should never be planted, or allowed to grow anywhere on the
component. Activities OTHER than mowing/maintenance (i.e. excessive walking, pets, vehicles, etc...) could
compress the component and reduce it's absorbtion capabilities and/or possibly cause it to freeze in winter
conditions. Lateral distribution pipes should be flushed out/tested every 18 months using the cleanout points
at each end of the component to remove scum that may clog orifices.
Performance Monitoring:
Performance monitoring must be done at least once every three years following the installation or at the time
of a problem, complaint, or failure.
Contingency Plan:
If the septic tank, pump tank or any of their components therein (including floats, alarms, pumps, etc)
become defective, the defective tank or component must be replaced immediately to ensure that the system
can operate as designed. If the mound component cannot accept wastewater or ponds wastewater to the
surface, the component must be repaired or replaced in it's current location by either: extending basal toe to
provide added absorbtion area; or by removing the clogged bacterial mat,aggregate cell, and distribution
piping within the mound and replacing said components in order to return system to proper working order as
required.
_ inn Sa2ups
a_
ac
_
0 2
78
U
a o I
C !s o
U Q z
as ~'o g
j6 g (A
p pub UJJ' b:
LO 3 11
16 29 (Y
0? -9
d a c w
~ ~ m m w
o m~ mg Oj~
SSZ
N 0 0
N
C - m N
o ~ ° r. 8.8 N ~
m ate= a~
a
LN O ~ v
OE p~
a~
0°
o
~
Qco
Pg6of6
V4:scdnsin Department 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 81/2 x 11 inches in size. Plan must minty - cre
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. Q 3bV
V
Please print all in or1606- t>fi Revi Date
330
Personal information you provide may be used for seo ndary purposes (Privacy Law, s. 15. (1) (m)).~
Prolm rty Location
Property Owner ,
~ n .
~M 8 t Govt Lot ,U 1/4 1/4 Sz3 T O N R -0 E (or p(J
Property owner's mailing Ad ss Lot Blodc # Subd. Name or CSM# d"M 619 r
City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road
uJC1~er~ Mtn Jb Z ( )3~-Z~k I 5~ - Jose 3V-,ii e-1
New Construction Use-J® Residential / Number of bedrooms Code derived design flow rate !V-5 Z,6 CJ GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material I i I Flood Plain elevation if applicable /f / ft.
General comments evYt Q v. 9 ~6
and recommendations: 5 S
0c, AID Lf t- e(-P- u.,
Boring # t❑ Boring G r7 p
` Lt pit Ground surface elev. a ft Depth to limiting factor L b 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
~ D-l2 10 r33 2 ~ ~5 Ivy .S
Z I Z-Zg la `t L Zrr ~ k C 5 .9 14 223:3G lo~6c~51 ~-Z"P 15 c-L Zn-ebk- '4~ L4 (P
Boring # ❑ Boring
Ej pit Ground surface elev. q ft. Depth to limiting factor 2~p 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
,vr ~S I v~c 5-
4milk
-14 r- l~ S;"l
o z I
Z r2-z~ r'j I z-
3 Zcp-40 r-4-1-► cz P 7,f -f1~ sG~ Zl k
Effluent #1 = BODs > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODs < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signatu a CST Number
12k cxn'1 Scku rv _ er 253
Address Date Evaluation Conducted Telephone Number
21 ~ 3 g6 Th . w c
1
Property Owner _&n64b An-1'es Parcel ID # Page 2 e o(~
F-31 Boring # 11 Boring
&pit Ground surface. elev. 59 49 o ft. Depth to limiting factor in.
Horizon Depth Dominant Color Redox Description Texture Struchue if Application Ra
In. Mansell Qu. Sz. Cont. Color Consistence Boundary Roots GPD/tl'
Gr. Sz. Sh. •Effa1 •Eff/12
r- 3 S1 2xr>~bL C J
2 2q
eq-~ 10 5/'
Boring # ❑ Boring
F-1 ❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rai
Horizon Depth . Dominant Color Redox Description.... .Texture -Structure Consistence Boundary Roots GPD/112
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#-)
Boring # ❑ Boring -
❑ Pit Ground surface elev. fL Depth to limiting factor in.
Soil Application Rats
Horizon Depth Dominant Color Redox Description Texture . Structure Consistence Boundary' Roots GPD/ftr
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
• Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent ill = BODS < 30 mg/l4 and TSS < 30 mg/l.
The Department of Commence 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.
SBaplO (R07/00)
I
Property Owner` 2> Ames Parcel ID 2
-0 Page of 3
Boring # 0 -Pit .7 .
. ! 0--Pit Ground surface. elev. , ~P o It. Depth to limiting factor 2-41 in. _
Soil Application Ra
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ 12
In. Munsell Qu. Sz. Cont Color _ _
Gr. SZ Sh. 'Eff#1
2 2q S k
; y c1 c ► 5
2y 1 5/4 c' Z'P 7. ~5 14
F-1 Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Snit Application Rai
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
a Boring # ❑ Boring
❑ Pit Ground surface elev. ft Depth to limiting factor In.
Soil Application Ralt
Horizon Depth Dominant Color Redox Description Texture . Structure Consistence Boundary Roots GPD/ftz
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
' Effluent #1 = BODS > 30 < 220 rngA- and TSS >30 < 150 mgA- ' Effluent #2 = BOD3 < 30 mg/l4 and TSS < 30 m9/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.
SBD1370 (X07/00)
PAGE_OF~
NAME Ca CI-; a u-,Q- i OT# LEGAL DESCRIPTION N% YK X ,S Z~ 14-6- N R _ 7cs E(or~
-
SCALE: I"=
yU
BM I ELEVATION /00.
BM I DESCRIPTION,6 p6 jc P.'b e
BM 2 ELEVATION 1 . SO
BM 2 DESCRIPTION
SYSTEM ELEVATION
SYSTEM TYPE I/YI yy - -
C NTOUR ELEVATION 7w
b w /
X13
~ i
o a ~ c I
C~
~d
i
ti
i
DATE g-z -IG
IGNATURE
r
.000000, 0011,
LCYr 45
r
f 3.00' ACRES
a ' • • • 130,741 84. FT. •
• • •+a 111
- .000
1 r
100,
' a
Lrcyr 4A~ : ' f
3.001 AMES
'OT
' 130,710 SQ. FT.
)01 ACF E$ =
,734 SO. FT.
L,.B.O.-884.0
AL
. .r
0 MANAGE
~ • EA8W A ~ •
-AT-
1
NOV44201E 3151 -W 8W442CM 129.
HERITAGE TRAIL---;-- - z
-~~89'+~4''W 129.60
r.9 2 $8~!44'2tYW 381.E 11 N ~ - - ~
1V
LocATION aarotl WUO PLAT OF:
a1AA
e
ee
SETTLER'S GLEN
MUMEN 110TOHAUpNP X
AN°,89~BIiNFOANrf1~iWF8Np
LOCHTOINPANTOPTNBNWV10PT11 M4,PANTOP' aNBUIOP'IIMBSWUI, WADOMTOMOD.
PANTOPTNNSNV40P'ITI65WII4PANTOPII3NR0I0113SBU4 THBSW9I0P
THN SNIN OP SNMN A AND IN PANT OP n3 NNV4 OP THE NW V4 OP 2MON IC
TMa AMP(T*13W,TOWNOPSLJ088PIf,5LCRODICOVMTT,W>9CONSNL
- - - - - _ _ - - _ _ an wM. w ONE oM r
y - omwold 40 «M w1 Ir.+1iy+x
° ~TAil7Efl~ltlKlN~l1C14!!4 8 8 « up my wttlrt w1 Ian as OEM eMtn
8_._--_.--_.-._.-•---•-._.-.----- -g -R p WE wnr wean an an WM wm
i « OR wry reran Ma 41111 wm wif4t
NNr41711Y10N.N tawe war MOVA an MA MMn mm
e w" a to as am won vw4n
DOT N0, 55•35•3471•20D3 a MID wr
gnrnY tan am 1101" won
Q . . - 1'NINNIAI' a wx Ma 4111' x14117 wu w Ira no no won
n
4MOOMf7S7 a Wa ON 11174117 ra w wort wm
Ywnr I a me MY am w ar OEM wwat
Ia I MOme ff#W al -M wl mom am
O wr wan tom w OE Mt own
i I lwf ma nv await 0111 ME OVA wort
ma troy 4_31131 as ar 31wrrt OEM
I , Cl tea atwr MOM aLa UM fal t WERE
UN'€9A4V9BW I i LOT I6 I ~pC~7193~) a 1111 ray wart as as 'a r won
iR t 1101 awAr waati an ra o n awn
/ 130 I I okk 1 1110 ww no ra am aawn w4"
8 I 0111% 110 on oarr wWN't aim ma NW alwn
111111`411111114114111! I f m l w wwtn *a au wwmn wwrmt
1 11r era' was ail wwm
Y awart
+ ' mm _m a 114141 p e Mown
w'tn
' C• ; 1 1111 mw wwur " ra Main son
, M CA WI 4w wr'U+ as 1111 Pon MOM
m qrr om m 11111 ow wtnn
aF / 4` 1 trm wwr r 1111 W Y wm KM
/ , w~~ i• M M m11 ar wr4n ow aw mm w"
"m unn as RE M" WM
r onn " will watt 414117
a 1741 w
IOTM / / m11 w r 11Mafn 31111 am - WE ONE.
i y
X" am w so 1AT41 i SoA a w mill ITM w v la w ~ mint,
amtAaaB _,7101OFL a wo ww x111117 A_ ar aawv won
rn MAN t/trw wnaan an as woman 41141'411.
111,iNaiR. 1 cm 1114 vrv won as ar won _Ala'n
co Ma mw mewl) sit 1111 won wwn
Lcrr4e M: 4 I IJIOBM _ a m°V1U ~ 41117117 w 17! OUR O M OE
t L110ACM 1 I a 4111 wrT a w AIa u wwn _M
I~a1l0 Ff. i 131.0..aA: a tea rwwl' _rwR Ina am _on owrt
1-•111 ` 1 IcuOrnArrlaIUNIF m 0 mJOE n3r won m Ka all WrA
m rrlr Malt wM ww WAM won
i gr_ " ~ I I t ar/w_atw,trmw u t 1111 rwr 31MVrt tea wM arwat aNtn
OAAIII@ ' , wMwtMl31iuuAluwwrA m
ell Lm I" arlr mom I an OM M IM
'k 1 71 [Heart A 0 ~ w u MW xrar on Ma 114117 wrwtrt
alrauxwwerl mm
i , ~ . I Anta[IrwruwawA a wt rrr wrrxt 1111 wa carat _Itrt
i n.wi•wA _ 1 I 1711 30
114111 ear rraan 114111 w N.V. OE ti
a watswwaw
Al L.--•-- wwwwwrww a 1111 war _rwn 41141 01r a7rgt mnlrt
i LOT 41 , tAtwtmwrrw x rr awr mw as rr mbv rra7rt
- r11
a wM 4141 17 u au wwt aaxt
MAaM 01~ w' 41~111111:1 m va err wrap au Ma mIm town
I -•F-NOtlTA01TRAe- e - - - w
Im Ma Nor amtn ma tar Moo. wart
maoFr. ( Iffi =-awwuraaww 11141 MV BOOM K4 as 111", 1 wm
•r
r ~ . ~ Y «Amaarauw no 4101 am wawa am A rrNa1 w
a aaram OR as wry "n u ma _wrt ararr
i
I,sa Cr!°- 1 I
MaaM w 1111 tarn wwrl 414 as awn OEM
.
d«4 t
31 Na ar'r rwalt 1117 1141 31atlU1 wwYfrl
i I I mamma a Y trra• wan NO ar ARM MOO
i 1 I n o mw
ir w 41: 0111 w 1" MFM
tt NO t
I __.31wA41wr a 1111 wrr woman as to Mart wmt
CA Y wtwr .0 Aa cal xn'11t wrwYl
\ I 1 _..-..-.•-warawrewl w aim NOV aa+IrAt 17111 MAO MEW IwA1rt
+ u na wr nnwat tra wu wan 1-001
'P ' LOT 71 I \ ' w REMOVED"
10771 LOT7f: 1 `\I Ar awtaawallaiarmrr
us AM
LOT 40 UODAa9 I30,7480.R. MAM.. \ \ amwwwluw ,
( 1X,11112 Fr 130,11102R.1, 1 \ nre N"Ymw_a
IaMart mv«at A wmLmw. SkNLANDSUAYBYRIGINC
\ 11117: m11MgAVwn 111111
y
wautrer
\ 31w"1q 111411 x~swwww~aw a
away
11111111
' oa01
~ \
' ~ Mawum11www
raawwawsMir 4 411111171141 A1aa
woo MOO to ocom a
mx 41,1141111 31X1,1 tan wmatttaei
~{y~w~wML 11a11141w $ :......::~nM
591aL~ lei , agawwm OA~aa 311111 1M
1
' ~ wlwAAm7wa!
tl MEMSAPM KM"Mwglan
wimr_atna
It All w 1141 013111 At It R 411111 0 Mal x x11141 Low 31171111 Naalaa 4141
MwwOKawawlvawaa31MwuwaWULx MMFM 1'•I0 to Mlow ath b" In a 6k C,* of bm* Iftwo
man OF A aMt nq if JIM a A MAU a 1111111 no • nlatlAa (la, ntak air M 1111 Atlr Y pd h)11111 MUa«I r.
wagp1mramnllulm Alva inn www x awn11w ® a~Iwy ~Ny adAaMaOAY OrI~raMi glaNMrwiwaiml wa om
w M nlnta naa am ma nom 1111n 31m x WA a , m • car 031awa"Asir
SHEET' T OF 6 rain caw
X111.4111
i
Mar so to 08119a RECEIVED • 1
ST. CRM COVNW
SSMC TANK MADA4TAM NANC E AMM MEM APR 0 5 2010
OWNM SWCMtMFlCATMFORM ST. CROIX COUNTY
PLANNING & ZONING OFFICE
OwvedBny~et• d'~.GGtTRAL ~a.w K _
MMUW Add.= ,R7 p 64pnt . 24 0 ~ 'rz* (~11r1~~i V ~ym fy 55b8 "Z
pt yAddrm j&A0 4e-jj) t~ y WAY NvAgl. igi Veik
city/stau w _ ^oa xa rrmnb~ ~30~a13! - j j
D
property I,oorwoa j~( , 1 ,Soc. _ , T N RAW, Ta~va of "T 1W6
roc0Ak.
sit
CexidiW Sbrvey► Map # .a Vobams . Page #
Warranty Dead # . Volow pw #
spw horse 7" tto J.+ot ow idontil a to m
laeptopa acs sttd of Pone s cmu mak ie its hotel a b wft wates• Beopm
mdaftuvm cooaka ofpeefw out as scrota teak #my theca yeas a wom r. ifeDOE! d, by a ►ioonsed pue0ttt: abe.%ImPa im
*06" lecai eat son the !booboo afa w septle to k as a tm m d is &a wsala d w"d system. owattr maitt Mm"
teapoaua'brlities arc spedtfad is ~Oovtooor. R3-SZ(1) and in (~ap~er 13 - Se. CSOnin Caid~~yOcd~foooa.
'i'be paapeihr owmr afoteee m eetbntit to St: Qroot County PInMSigp B Zted~ Dspattmeee a oati6atios skeet. sf~aee ey ~
owner tad by a eoasea<plambae; joumayssre plwoobm. aateciate I phi or a lioaesod pnow vaiadq qm* (3) at mot
vneftwatoc dispwal syatmn is is peopra vpe+aaoai ooadieoa and/or m p ~mdpwa;i.g (ii'a.oa4.ei~. e►e aeptie ark is
lore tiam 1/3 ful[ ottdadpa
lfwa. Bte mdees~psed Axw tad Us above togo~osCt and ~'w ee ~ossiotslatb pehsM sswep ~ systeat wilMtle
=MUM*" fort, b=* as oral by the Depotostase ottbteeoaoa atd ties Dapnemeeet ofldsaml Raagwaay SWs aR Wsrooea:~.
Cortillaatloa #so td that yw septk system bss beta=xhmhtad ooaet bo oom oomd sad ummed *do 9L (kart Cbmoiy Pbudas AL
Zoeatg Depatammt withal 30 days ohlte 6= ym mtpaatioo *AL
Uwe cod* that a5 aasemsete oa thb mem tare ttoe oo the bat of tpyrow taeowieftL lhoe atttrs G As owaet(s) aldra
propatQr doarnbed abovq, by vieats aoF• wantmly dead twoadod ar Rtt=eruc adl')eods O~oa
Nam of bo~roottme ~
SIGNATIME OF "PLMAMS) DAZE
Wy i dbw=dm Gist is aJ=spt svAod way ammu Im de asdtaypatok beipa vovabd by the Pbmfoa do ZorA ft Dopmomet
iadlodo wob chic appliatim a scow" wounoW dmd boa As Rogue rof Desch Of&* *Oda GVY OCAS G*n"=Pff
WO&M w is made m the VAMNty stood.
(p".
t i Ililil iliii Iliff ilHi ~i11f lllil l~l~lif1111I11 iffi
* 9 0 3 5 2 2 2
993522
BETH PABST
REGISTER OF DEEDS
Return to: ST. CROIX CO., WI
RECEIVED FOR RECORD
Central Bank LAND ME, ,NC' 09/10/2009 03:30PM
22 Frontage Road West SUIT 200
j9W DEED
P O 225 SILVER j!j 66112 EXEMPT 1 10
Stillwate , MN 55082 t REC FEE: 13.00
FILE rl PAGES: 2
PID#: 030-2131-44-000
13~
DEED IN LIEU OF FORECLOSURE
(Minnesota corporation to Minnesota banking corporation)
Dated: September 8 , 2009. Consideration for this Deed is less than $500.00
FOR VALUABLE CONSIDERATION, Manchester Homes, Inc., a Minnesota corporation
("Grantor"), does hereby remise, release and quitclaim unto Central Bank, a Minnesota banking
corporation ("Grantee"), forever, all right, title, interest, claim and demand which said Grantor has
in, and to, the following real property located in St. Croix County, Wisconsin, legally described as
follows:
Lot 44, Settler's Glen located in the Town of St. Joseph, St. Croix County, Wisconsin
("Property"),
to have and to hold the same, together with all hereditaments and appurtenances belonging thereto or
in anyway appertaining, and all the estate, right, title, interest, lien, equity and claim whatsoever of
said Grantor, either in law or equity, to the only proper use, benefit and behalf of said Grantee
forever.
Grantor is familiar with the Property and certifies that the status and number of wells on the Property
has not changed since the last previously filed well disclosure certificate.
Grantor represents and warrants to Grantee that the Property is not in violation of any federal, state,
county, municipal or local environmental laws, ordinances or regulations.
1 of 2
It is Grantor's and Grantee's intent that Grantee shall not be deemed to have merged its
interest as Mortgagee under that certain mortgage, executed by Grantor, as Mortgagor, in
favor of Grantee, as Mortgagee, dated May 14, 2004, and recorded on May 17, 2004, as
Document No. 762687, in the Office of the Register of Deeds in and for St. Croix County,
Wisconsin, with its interest as Grantee hereunder, and any and all other mortgage liens and
assignments of leases and rents, if any, held by the Grantee shall remain in full force and effect
to protect and preserve the priority of the Grantee's mortgage liens and assignments of leases
and rents and the foreclosure and collection rights of Grantee in the event of the existence of
inferior liens or encumbrances, and said mortgage liens and assignments of leases and rents
shall so remain in full force and effect until and unless satisfied through foreclosure or
satisfied in writing and recorded by the Grantee.
Manchester Homes, Inc.
(a Minnesota corporation)
By: C2~~j
Gregory A. Jo s
Its: President
STATE OF MINNESOTA
COUNTY OFwASHld7G+i04 ~ SS
The foregoing instrument was acknowledged before me this 8 day of September, 2009,
by Gregory A. Johnson, the President of Manchester Homes, Inc., a Minnesota corporation, on
behalf of the corporation.
SCOTT J BROMELKAMP
y (Votary Public ,
Minmots
gion E {anus 31, 2011
Notary Public
THIS INSTRUMENT WAS DRAFTED BY: Tax Statements for the real property described
ANASTASI & ASSOCIATES, P.A. in this instrument should be sent to:
14985 60'' Street North
Stillwater, MN 55082 Central Bank
(651) 439-2951 2270 Frontage Road West
NCJ/#14511 P O Box 225
Stillwater, MN 55082
2
2 of 2