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HomeMy WebLinkAbout030-2127-80-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSP7CTION REPORT Sanitary Permit No: x , 453088 0 GENERAL INFORMATION (AT,,ACH _'O PERMIT) State Plan ID No: Personal information yoy xovir!,- : «ay be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Delaney Company St. Joseph Township 030 - 2127 -80 -000 CST BM Elev: Insp. BM Elew BM Description: Section /TownfRange /Map No: 106, 25.30.20.1042 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STA X a S HI FS ELEV. � 1 - Septic Benchmark r. 6� a'U 0 Dosing v ; i, � 6 _ 3 Alt. BM Aeration Bldg_Sew r G'' 2 -o /a G Holding S Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO PP/L WEE L BLDG. Vent to Air Intake ROAD Dt Inlet / Septic ) 5� / h I �2 D Bottom k 77 ./ 3 Dosing Header /Maw_ /O / • Z Aeration Dist. Pipe Holding Bot. System 9 -/ Gov -s ✓ Final Grade / PUMP /SIPHON INFORMATION '-- Manufacturer Demand St Cover f / GPM �o ' 0 3 .2 Model Number S z 4 q ioa TDH Lift , Frictiln Loos System Head TD Ft `7 y G Forcemain Len q U / ria. Z Dist. to Well �- SOIL ABSORPTION SYSTEM BED/TRENCH Width Length t No. Of Trgn hes PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /] / ./ SETBACK SYSTEM TO P /L• BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: 2 . UNIT Model Number: DISTRIBUTION SYSTEM Heade /Manifold Distribution x Hole Sizw U x Hol pacing Vent to Air Intak � I Pipe(s Ap Length 4 DDia 2 l Length � Dia /•r , Spacin g_ � / � � - o SOIL COVER x Pressure Systems Only x x Mound Or At - Grade Systems Only Depth Over IDepth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed/Trench Edges Topsoil Yes ? No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / 6 Inspection #2: X // 1.) Alt BM ` 7 Location: Description C? Y Ti h Park Hudson l 54016 (E 112 SW 1/4 25 T30N R20W) Birch Par�L� 8 Parcel No: 25.30.E0.1042 � 2.) Bldg sewer length = 0-5 1 - amount of cover Plan Use other for additional in_ Yes No formation. — Date Insepctor's Signa e Cert. No. SBD -6710 (R.3/97) CO r"Ir CD t"NIX UNTY A& IL PLANNING & ZONING Tuesday, May 06, 2008 5+"+j . t. >. Delaney Company 1360 Birch Park Circle Houlton, WI 54082 �F Code Administrati Regarding septic inspection for Delaney Company. 715- 386 -4680 a: f ` Location of Property in St. Croix County: Land Information cg Planning Municipality: St. Joseph, Town of 715- 386 - 4674. Subdivision or Plat: Birch Park Real Certified Survey Map: 715-4677 Lot: 38 Rclrng Address: 1360 Birch Park Circle b- 386 -4675 . Dear Applicant: y A septic inspection of the above reference property was conducted on August 24,2004. 0. f This property is located in the E 1/2 SW 1/4 of Section 25, T30N R20W, Birch Park (Lot 38 ), St. Joseph, Town of, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a 4 bedroom home. h' \'t Additional Notes: Permit was revised on 6 -14 -04 received to increase size of mound. Installed 4 BR sized system per approved plan revision If you have any questions regarding this, please contact our office at 715.386.4680. Sincerely, n Pam Quinn 1 =' Zoning Specialist ix cc: file ST. CRO /X COUNTY Go UERNMENT CENTER 1 101 CARMICHAEL ROAD, HUDSON, W/ 54016 7153864686 FAx PZPCO.SA /NT- CRO /X. W. US W W W. CO. SAI NT- CROIX. WI. US Safety and Buildings Division County n ' 201 W. Washington Ave., P.O. Box 7162 (moo 1 Al viscohs��. Madisow-, Wl 5' - 7162 Sanitary Permit Number (to be fulled in by Co.) (608)266 -3151 Department of Commerce State PlanLD.Number ivz r r.077 Sanita Permit Application x In accord with Comm 83.21, Wis. Adm. Code, personal information you provide Address if different than maildress) maybe used for secondary Proposes Privacy Law, s15.t}t(lxm) J 1 nal P � 1. Application Information - Please Print All Informatio , F1 V ED rjr/ 1�iD !'a ngt Paroel H Lot k Block a i Property Owner's Name 3 ry r�itJ� UW i '� >t�04 X property Location Pr rt Owner's Mailing A-= VS ZONIN '/a Section t� City, rate Zip Code (circle one) T 3 ' N; R E or 11. Type of Building (check all that apply) ! v l --� ubdivision Name CSM Number (I or 2 Family Dwelling - Number f Bedrooms Q� �R `_ boo • o fa.�t t ❑ Public/Commercial - Describe Township of I ❑City • Village ❑ State Owned - Describe Use l � III. Type of Permit: (Check only one box on line A. Complete ling: cable) 03D- 2 - 7 " fOT A. New System ❑Replacement system 13 Tteatment/Holding Tank Replacement Only C3 Other Modification to Existing System List Previous Permit Number and D Issued B. ❑ Permit Renewal Permit Revision C3 Change of ❑ PermitTmnsfer to New ` 453688' 4 4 1.3'0 Before Expiration Plumber Owner 7� IV. TyRe of POWrS System; jCbeck all that appl 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑Single Pass Sand Filter ❑ ❑ Non - Pressurized ht- Ground > ound _ ❑ Constructed Wetland ❑ Pressurizod In -Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter Recuculating S thetic Media Filter ❑ LeacbiM Chamber ❑ Drip Line ❑ Gravel -less Pi ❑ Other (explain) V. Dis ersal/rreatment Area information: Design Flow ( EpDcsLgn oil Ap plication Rate(gpdsf) Dispersal Area Requ' ed (sf) � 0 0 Dis I Area Proposed (sf) System Elevation • 3 Zoo /"1 Prefab Site Steel Fiber Plastic V1. Tank Info city Total Number Matt setter Concrete Constructed Glass llons Gallons of Units New Existing Talcs Talcs Aerobic Trcarmcru Unit DuwinK Chnmbcr VII. Res nsib(11 Statement - 1, the under ed, ass um nsibW for Installation of the POWTS shown on the attached plans. Plu Name (Pr' ) PI s Si t MP/MPRS Number Business Phone Number P umber's Address (Street, City, State, Zip b f £ t�i16 vYl/ V111. Count /De artment Use Onl Sanitary Permit Fee (includes Groundwater Date lssuod lss trig ent Signature ( o Stamps) 1 Approved ❑ Disa roved Surcharge Fee) ( f LA ❑ Owner 1X. Conditions of proval/Reasons for Disapproval 3` , SYST M OWNER: / 1 C-� t s `or.► rc.ce.t�aQ -� o I`1 -ClQ« S Li 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained S-e Sow tuQA i try ,rte as per applicable code /ordinances. t Lap Attach complete plans (to the County only) for the system on paper not k an s nahv Eo filter SBD -6398 (R. 01/03) 1 b r ' v ( I� p A f ,vyO w s cot CI O t►I CA 00 .' AD N n d B a Z \ p f j 2 � D � d 0 � V A ✓0 - 5 J d .n t A N _ -x as o 4 ^c J I r � � Safety and Buildings commerce.wi. OV 4003 N KINNEY COULEE RD g LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 'sco n s i n www.commerc .wis ons • Department of Commerce www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary May 26, 2004 CUST ID No.222774 ATTN: POWTS Inspector HENRY F GROTE ZONING OFFICE CERTIFIED SOIL TESTING ST CROIX COUNTY SPIA E4366 353RD AVE 1101 CARMICHAEL RD MENOMONIE WI 54751 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRE : S 05/26/2006 Transaction ID No. 1002877 SITE: Site ID No. 671594 Delaney Company Please refer to both identification numbers, 1360 Birch Park Circle above, in all correspondence with the agency. Town of Saint Joseph St Croix County I E1 /2, SW1 /4, S25, T30N, R20W Lot: 38, Subdivision: Birch Park FOR: Description: Proposed Four Bedroom Mound System - Revision Object Type: POWTS Component Manual Regulated Object ID No.: 946074 Maintenance required; 600 GPD Flow rate; 37 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 101), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 /01); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The approved changes will become an addendum to the plans that were previously approved on April 1, 2004 under Transaction ID No. 976575. 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 approved plans, and the "Mound Component Manual for POWTS - Version 2.0" SBD- 10691- P(N.01 /01). The pressure network is to be constructed in accordance with publication SBD- 10706- P(NO1 /01) "Pressure Distribution Component Manual for POWTS - Version 2.0 ". • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. 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 Comm 84 product approval conditions. • Comm 83.22(7) - A copy of the approved plans specifications and this letter shall be on -site during construction and open to inspectioi }kldri�etrepresentatives of the Department which may include local inspectors. co Idititoll�'14 D n iu '% '.I La 6i M3 HVNRY F GROTE Page 2 5/26/04 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review 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. Sincerely, Fee Required $ 60.00 &eZ)6-� Fee Received $ 60.00 Gerard M. Swim Balance Due $ 0.00 POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm jswim(acommerce.state.wi.us WSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 I ' 1 Delaney Company - Mound Construction Materials and Techniques All materials must comply with Comm 84 and be installed in accordance with manufacturer's specifications. Construction methods must comply with the following Component Manuals: Revision to Transaction # 976575, Site ID # 671594 Mound, SBD - 10691 -P (01 /01) Pressure Distribution, SBD 10706 - P (01/01) Location: Lot 38, Birch Park E '/2, SW '/4, Sec. 25, T 30 N, R 20 W Town: St. Joseph County: St. Croix Date: May 24, 2004 Owner: Delaney Company, LLC Address: 970 Labarge Road d 3N Hudson, W - o , I 54016 7619 � .. • • • • i ��� Avo Designer: , Hgnry Grote — e p : Si Signature: �d g � N �y ' �C: License: WI D -1 9 -007 ��` 1 111111 Attachments: SBD -10577 - Plan Approval Application SBD -8330 Page 1: cover 2: design criteria & calculations 3: plot plan 4: system cross section RECEIVED 5: plan view, lateral detail 6: pump tank exit detail MAY 19 2004 7: pump curve 8: system management SAFETY & BLDGS DIVe r t `. 1.1.0 IV "L1 page 1 of 8 DEPARTMENT Of COMWERCE Wt51U�i AFLIY AND BUILDINGS I SLL CORRLS NDENCE Design. Criteria Residential Wastewater Contaminant Load: 30 mg/L < BOD < 220 mg/L Anticipated septic tank effluent 30 mg/L < TSS < 150mg/L Fecal Coliform > 10,000 cfu/100 mL Fats oils ease < 30 mg/L �' g Bedrooms x 100 gal/bedroom/day x 1.5 gallons /day hydraulic load Design Calculations In situ designed loading rate C gallons /sq. ft. per day Depth to estimated high ground water in. Depth to bedrock in. Cross slope at system t ° % Force main length S" 3 ft. of in. Manifold/header length ft. of 2 in. Drain -back Z `� gallons Lateral length ft. of Z in. Lateral elevation / n ft. @ bottom of lateral Lateral hole size in. @ 3 b in. ( 3 o ft.) Spacing s ` 3 holes /lateral S Z holes total Lateral volume 3 g gallons Total lateral discharge rate 4.32 gallons /minute @ Sl ft. head i Network pressure compensation losses 0 , 4-S ft. Elevation difference �• S� ft. Friction loss ft. @ 3 S� gallons /minute Total dynamic head ft. Pump /sip4on S 3 ; $pm @ l S� ft. of head Manufacturer ° Q_ Model # `� Z Dose volume 1 S" gallons Lift/siphon tank w� w t�� - s'n Co S gallons Septic tank gallons Effluent filter O v Q - rj J.� Measurement pump on and off in. Height alarm from tank bottom in. Reserve capacity 4jct S� gallons specs.calcsses Page 2, of g C { j J z N rr OJJ DOI �t `'�► v to I s� to _ a / 0 j Z S Q o � y ` M �n + r A J o z ,e �• a x ,, 1.__.._...__x.5. - -• - __.. . ILv (Ole • ,. 30,x' OLL% l lI 04.1 \Iia 0.Vj v►w��.Il `� /1 �. i 3 CL t cc) ._, } �` aH V : mow.,. • 3o•g i 1 ' �.cq, j. -2b s` O'. 4" �- a � )p •.� S� v C o ` S �r v � �-: o h ..� a 11 � }-p b • i � o ... o � r o L � b •••� Z }� R I l - JL / F I -04\ • /� � � o\ a - S o ... 1 �'� a. t ►.� ts.,�� °Ji b o � o .... \ : � +y � � `� • � o.�(+ y � l � • p w-. �N o \ c U 1 I MnH I WEA'CNERPRO�F LOCKING COVER JUNj Ch lt/A/1�N /N� G1111CK Dt�C.OVUICt--1 ~� T 4 iii,.• DIP6 3 no NOISTua�ED SOIL_ 2 24 \ �'t•,c�� A � 1 A Z� o awa.ovc..D - ( 3bMJ WFL.E j RI_L P^ 0, d .L AL 3 c>- n I a 4 o Y c9 w,.ao a" PualP i D 9,% I co RFrc SEPTIC t SPEC.IFI o 005C 1 1 �,(` � c �� Teti' MAWUFACTURCR: �+ +� IJ UMBER OF OOSCS. _PEk TAWK SIZE ; i ZS ' GALL0QS .'DOSE VOLUME ALARr1 M/WUFAC7UKLR; S `� �'-��� IWCLUOIWG 6ACKFLOW: S 3 S /',OOCL WU{�[R: } CAPACITIES: A= �`�` IUCHC5 OK SWITCH TyPG: B= IwcHE$ OR C a S IQC HE 5 OR MODEL IJUMDCR; �, Z D ■ � ft. HES OR SWITCH TUPC: �M2.t� v w .� uQTE; PUMP AWD ALARM ARC TO DE Ml JIMUM DISCHARGE R GPM INSTALLED OQ 5EPARATE CiK�- VERrICAL DIFFERCWC( OETWCEU PUMP OFF AUO DIJTRIDUTIOW PIPE.. b FEET + ►JETWORK SUPPLY PRESSURE • . . . . . . 2 `� FEET + S 3 FEET OF PORC[ MAIW X 2 _ �� f %0 /zFRICTIOU FACTOR. = FEET \�,� TOTAL Dy1JAMIG / NEAP z L FEET ItJTER►JAL DIMCIJ510AJj OF TAQK: LCKI CPT H..�_;WIDTH �� ;LIgUIC) 0 EPTH • TOTAL DYNAMIC HEA15 /CAPACITY HEAD CAPACITY CURVE PER MINUTE EFFLUENT AND DEWATERING N Ln MODEL 152/153 w w MODEL 152 153 50 Feet Meters 0,171 Liters Gol. Liters 153 5 1.5 1 69 261 77 291 12 40 152 10 3.1 61 231 70 265 °a 15 4.6 53 201 61 231 = 20 6.1 44 167 52 197 L , 30 z 8 25 7.6 34 129 42 159 r 30 9.1 23 87 33 1 2 5 20 35 0. — - - 22 85 � 17 l 0 40 12.2 -- -- 11 42 4- Lock Valve: 38.0 Ft. ( 1 1.6rr) 44.0 Ft. ( 1 3.4m), 014W8 0 20 40 60 80 100 GALLONS LITERS 0 80 160 240 320 5 i/4 3 27/32 4 5/8 -7 FLOW PER MINUTE ( - I CONSULT FACTORY FOR SPECIAL APPLICATIONS 3 27132 ;-- • Timed dosing panels available. • Electrical alternators, for duplex systems, are available and supplied with 3 27/32 an alarm. 1 _. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Qwik -Box available for`outdoor installations. See FM1420. _- __ - - -: • Over 130 °F. (54 °C.) special quotation required. - 1521153 Series 2 /� _ __ 1521153 MODELS Control Selection Mode _ Volts-ph Mode Amps Simplex Duplex N152 T 115 1 Non 8.5 1 2 or 3 _BN 115 1 Auto 8.5 Included 2 or 3 1 1 sKZOS. BE152 230 1 Auto 4.3 Included 2 or 3 N153 ' 115 1 Non 10.5 1 2 or 3 BN 53 1 1 Auto 10.5 Incuded 2or3 SELECTION GUIDE E 153 230 1 Non 5.3 1 2 or 3 E153 230 1 Auto 5.3 Included 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FMO477. v CAUTION 2. See FM0712 for correct model of Electrical Alternator E -Pak. All installation of controls, protection devices and wiring should be done by a qualified 3. Variable level Control switch 10 0225 used as a Control activator, specify duplex (3) licensed electrician. All electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). or (4) float system. A RESERVE POWERED DESIGN U� For unusual conditions a reserve safety factor is engineered int the design of every Zoeller pump. MAIL TO: P.O. BOX 16347 Louisville, KY 40256 -0347 Manufacturers of. . L O SHIP TO: 3649 Cane Run Road ® Louisville, KY (800) 9 2 8-P UMP QV.4L/r,' PUMPS S ,VC, �ff7 (502)778 - 774- 3 928•PUMP http: / /www.zoeller.com LJ�Y�/- FAX (502) 774 -3624 © Copyright 2000 Zoeller Co. All rights reserved. System Management Management of this system is critical. As a condition of approval of these plans this system management section must be eviewed with the owner,.and the owner must be provided with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber, TL Sinz Plumbing, 715 -235- 2644, or the St. Croix County Zoning Office, 715- 386 -4680, should be contacted for assistance. General Proper functioning of an on -site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or compartment to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. 1. If the septic tank is installed prior to sheet -rock and /or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. 2. Install water - saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. 4. Never pour grease or oil down any drain or stool. 5. Garbage disposals are not recommended; if you must have one, use it sparingly 6. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. 9. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans. 10. If septic or pump tanks are no longer used, they must be properly abandoned. 11. If construction timing and weather could create a frozen infiltration system, weather - proofing with plastic sheeting and heavy mulching may be required to maintain a functional system at start-up. Maintenance 1. The septic tank must be inspected every three years by a properly licensed person. 2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. 3. When the septic tank is pumped, any solids in the bottom of the pump tank must be pumped, and the filter must be back - washed into the septic tank to remove accumulated material. System use may require more frequent filter cleaning. 4. Periodic observation pipe inspections should be made by the homeowner to examine the state of the in -situ soil adsorption cell. Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. 5. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. 7. Avoid compaction such as vehicle traffic within 15' down -slope of the adsorption system. 8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run -off into the system area. 11. Warning: Do not enter septic, pump or other treatment tanks; death may result because they may contain lethal gases or insufficient oxygen. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing, and /or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 Safety and Buildings Division County e �� X y o ) ` 201 W. Washingto ve., P_0. Box 7162 W SCOfISfI"l, MadisoYt, l 537 rte- � � . - San itary P Y 'umber (to be fi in b (dOg 266 3 IG r w (J epartment of Commerce'" Fn? Statet Plan LD. Num 'TRIW IQ ^ � S) Sanitary Permit Applicat on A0 �S'9�5, 10.) 0 R P Ord with Comm 83.21, Wis. Adm Code, personal inform an you pro�ilie ( �y Il ,� tray be used for secondary purposes Privacy Law, s15. 1 xm) Add (if diQerent than 'lin address) S-.- 1. Application Information - Please Print All Information arcel N N Property Owner's Name y Locati 6 Property Owner's Mailing ess 9 a r�-,o j - 7 C_ 'h, section City, i rate Zip C / de Phone Number `CDI (Q5'�-SC7434I T N; R 0(c Eo e r� ) 11. Type of Building (check al at apply) ` vision Name Qc " *<r 2 Family Dwelling - Number o ooms fl� QG � � � (I PublirJCoawxrcial - Descri sc �� �. � `Owned 7 y Use tai x t City_ ❑Village [)Township of ll 1. Type of Permit: (Check only one oz line C plete line B I applicable) A. Ifrlvew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement y [] Othe fication to Existing System st N B. ❑ Permit Renewal ❑ Permit Revision Change of ❑ Permit Trans to New li Before Expiration PI Owner IV. T e of POWTS S stem: �Chheeck all that a 1 [I ❑ NIound > 24 in. of suitable soil Mound < 24 in. suitable soil At -Grade ❑Single Pass Sand Filter ❑ Non LK - Pressurized -Ground ❑ Constructed Wetland ❑ Pressurized In -Ground ❑ Holding Tank Peat Filter Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ 1) Recirculatirr S [befit Media Filter ❑ �� ❑ � el -less Pi C1 � V. Dis ersal/1'reutment Area luformation: stem Elevation Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area iced (s0 Dis p / 1� �Pro (sO Y 454 •.2G9 f.o st � QQ 17 ? t in Total Number u itc Steal Fiber Plastic V1. Tank Info Capacity factur Prefab S Constructed Glass Gallons Gallons of Units Concrete Ncw Existing Tanks Tacky Sep(ic U Acrobic Trcatmctu Unit (/ V r Du inK Chambcr DD V ll. Responsibility Statement - 4 the under ned, assume slbL11 for 1�� Nf tuII]h WTS shown on the & Number Plumber's Name (Print) PI s Signal Plumber's Address (Street, City, State, Zp ) �,S?o09 ?, I tss S�F ?�/ Vill. Count /De artment Use Onl 'tars Permit F (' chides Groundwater Date lssu lssuin gent Signature No amps) proved ❑ Disapproved Surcharge Fee) �[� ne ❑ Owner Given Reason for Denial 3 M, , IX- Conditions of Approval/Reasons for Disa roval SYSTEM OWNER: 1 Septic tank, effluent filter and 1 "1 CA dispersal cell must all se ed / maintained f per-��� as per management plan provided by plumber. r , 2. All setback requirements must be maintained�.y��,,� as per applicable code /ordinances Attach complete plans (to the County only) *the system on paper not ku than SIR s It Iaebes in �[) 4LkU_ SBD -6398 (R. 01/03) T t V�,A�hM� • , �� /"�; 73 0 -L _ % V Y . a. t A� 1 1 4 t� Z � 4 s - 1 O v 0 d d tA . ° 4 . A _ co I Safety and Buildings ' commerceml. ov 4003 N KINNEY COULEE RD g LACROSSE WI 54601 -1831 TDD #: (608) 264 -8777 iscon 'sin www.commerc ons Department of Commerce www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary April 01, 2004 CUST ID No.222774 ATTN: POWTS Inspector HENRY F GROTE ZONING OFFICE CERTIFIED SOIL TESTING ST CROIX COUNTY SPIA E4366 353RD AVE 1101 CARMIC1 AEL RD MENOMONIE WI 54751 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/01/2006 Identification Numbers Transaction ID No. 976575 SITE: Site ID No. 671594 Delaney Company Please refer to both identification numbers, 1360 Birch Park Circle above, in all correspondence with the agency. Town of Saint Joseph St Croix County E1 /2, SW1 /4, S25, T30N, R20W Lot: 38, Subdivision: Birch Park FOR: Description: Proposed Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 946074 Maintenance required; 450 GPD Flow rate; 37 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual - Version 2.0, SBD - 10706 -P (N.01/01) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. 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 approved plans, the "Mound Component Manual for Private Onsite Wastewater Systems Version 2" SBD- 1069 1 -P(N.0 1 /0 1). • The pressure network is to be constructed in accordance with publications SBD- 10706- P(NO1 /01) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems - Version ZA ". • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. 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 Comm 84 product approval conditions. • Comm 83.22(7) - 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 in e o s. xi tf. T Conditiani �� �, /mil . ti ' • • {,�* HENRY F GROTE Page 2 4/1/04 , Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review 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. Sincerely, &406-� Fee Required $ 175.00 Fee Received $ 175.00 Gerard M. Swim Balance Due $ 0.00 POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm jswim @commerce.state.wi.us WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 Henry F Grote, Certified Soil Testing I i Delaney Company - Mound Construction Materials and Techniques All materials must comply with Comm 84 and be installed in accordance with manufacturer's specifications. Construction methods must comply with the following Component Manuals: Mound, S BD- 10691 -P (01/01) Pressure Distribution, SBD- 10706 -P (01/01) Transaction ID # 976575 - Site ID # 671594 Location: Lot 38, Birch Park E' /z, SW '/4, Sec. 25, T 30 N, R 20 W Town: St. Joseph County: St. Croix Date: March 31, 2004 Owner: Delaney Company, LLC Address: 970 Labarge Road Hudson, WI 54016 -7619 G O NS ` 5 ........ Designer: Henry Grote' HENRY F _ GROTE Signature: ENoMON License : WI D -169 - 07 O � ft! ;'�' O-sti � N. Attachments: SBD -10577 - Plan Approval Application SBD -8330 — Soil Evaluation Report Page 1: cover , 2: design criteria & calculations �����' p r � M n f -. 1 1 E., r% 3: plot plan 4: system cross section y DEPARTMENT of COMM. 5: plan view, lateral detail AfE7Y AND BUILD ±(�G� 6: pump tank exit detail 7: pump curve _ C . _ OFZRESP DING .,, sstmanagement DkPARTMENT OF COM riERCE D!V1 RECEIVED page 1 of 8 5lON SAFETYANB 6UiLDIG t�� SEE CORRESP OLNGE MAR 3 0 2004 SAFETY & BLDGS DIV. Design Criteria 'd Residential Wastewater Contaminant Load: 30 mg /L < BOD < 220 mg /L t Anticipated septic tank effluent 30 < /L m /L < TSS 150m I p p � g _ g j Fecal Coliform > 10,000 cfu/100 mL Fats, oils, grease < 30 mg /L 3 Bedrooms x 100 gal/bedroom/day x 1.5 gallons /day hydraulic load Design Calculations In situ designed loading rate 0,-L6 gallons /sq. ft. per day Depth to estimated high ground water in. Depth to bedrock in. Cross slope at system % Force main length 2 0 ft. of in. Manifold /header length 3 ft. of in. Drain -back � gallons Lateral length ft. of Z in. d Lateral elevation 1 ft. @ bottom of lateral Lateral hole size ���e in. @ 4 g� in. ( 4 ' ° ft.) Spacing \ � holes /lateral `� holes total t �3,Z j . La eral volume gallons 1 � I Total lateral discharge rate gallons /minute @ 2 S ft. head Network pressure compensation losses Elevation difference b' ft. Friction loss ft. @ Z S� gallons /minute ld n� Total dynamic head ft. . Pump /sifton gpm I ft. of head Manufacturer 0 �� Model # Dose volume 1 �� `S gallons Lift /s#on tank c. gallons Septic tank ' `�'�'° gallons Effluent filter Q '_ c- V- (D 't J -'C� C Measurement pump on and off s�� in. Height alarm from tank bottom \ ' in. Reserve capacity + gallons specs.calcs.res IC Page of 8 Cr 01 .011 Sol t .A I } a t � n a J ~ � a n v u f d z � 6 c� J 41:7,N t� t J 4 -� _ C4 (((fff{ J S t4 rn v t S ! off ` Ct9,$3 a a.n � O1, / O 1p 1 11 S N 1 i I s� N o Yi! l 4T Goo 4 s O'. 4 �- a � )p •.� (� v C o \o S a-v� v .r i�: o ., ... a,1 � i-O `O • �k � o ... o � r o t K `� 1 c 1 1 lb 4-0 1 nn CJ ��•�Q���DC 4-� 1��`vt �•xaC of o� o �. Qa,., �- \m o A (� 6 \Vll CA IL f a� ,r • WEATNERPROJF LDCKIWG covER JtiNCTlorr IvA�N ANC c 4'8W � . 8c X QvICK Dlacouv1CT ---1 I � I L PIPE 3' no NDISTURbE0 P� SOIL 24u 2.D. ►I 4" 4 /4" T , I v Cras�a j � I � 4 54 r ot w< WFLE c AL �AL i C0NkV nT0�v F ON � m - Ig�3A 'r t j � JRDUHO Clev \T�v r 0 w�la.1 S0 �Z P u,rlP co�rc.RE-r� ..E�F� bcoCK SEPTIC f S PEG F • I ICATIOIJS DO 5 C 1 ( k , �-�- � w,�,�' l9 TA U S MAWUFACTU t'} QLLMBER OF DOSES; �� TA►JK SIZE : � - V� GALLOW S DOSE VOLUME EK x LUME ALARM M XILIFACTLIKER: S `� ?� �c.� IWCLUDING OACKFLOW: 0A , MODEL WUNk15ER: , ° � �'� � 1 CAPACITIES: A = -Zl"' to WCHES OK V"rQ.Y v w \ �p SWITCH TyP[: u B'= Z ' IWCHES OR NUMP /1AWU FACT URCR: S u�� F �0 C ° IuCHES OR � ,5 MODEL uUMecR; 13 4 .1 D � �' J : v �/'sQ.v K INCHES CR (VA 5 WI 7 CH TVPC .. __ MOTE: PUMP AW ALARM ARC TJ bC M'WIMUM DISCHARGE RATE '2 � INSTALLED Ow 5EPARATE CIAu%Tg GSM L VERTICAL DIFFEKEKIC[ DETWCCIJ PU" OFF AUO OISTRIDUTIOIJ PIPE_ Lc '� FEET + MIuIMUM NETWORK SUPPLY PRELLURE . . , . . . . , , . , 2,S' p + L FEET OF l.3 Ft FEET �I � FOR MAIIJ X Yo FzFRICTIOW FACTOR. �' g FEE T z S TOTAL OtJWAMICC, HEAD 00 3 FEET IU7EKIJAL, AJ DIMEW510A1>; OF TAK :" LEWC,TH 2 :WIDTH ;LIQUID DEPTH P ain 6 �0. b y 1 E ng i neer i ng / • Pu Char acteristi cs Performance Data ►wo IA•tor ud, S Wnrs01+ AvItre k N44h SN1130A1 t T » FA toed Amp LO m4la S6" Nk 14 1 R.►JA. 1 SS0 � Vak i1S Nsrfz b0 I I WMW#*# 12 "f AptWonf NMA D+s4a A N a t 1 ir,s> Gm A 1.1 /Z, Nry (341W Total R h4►t 4 i 12 16 ZO 44 OWW" SOW Wu &q 3 /4.09nig ON (U.S.) 44 36 1 29 1 23 1 12 0 Udt wool 30 6s. hwsr Cud 15/3, SPW, 40r shL Dimensional Data Materials of Construction rte" �M " 11 uI t. (or""I !� P141041110 P141041110 Slsdslrss S1W ,.,� Li my 2 V1 in.S LYbrtt* CO DWKIrk Of ail y' i S � M" I WIAW R4ets�r NWus Got kw �.. c.�os o PVW a ' I S. Rn/OH Mvsl o�a�oY� Cm (swt keg d, We rasm Ar * to Wh is sv FWUO ad #4 OWAG icd SW Fam: UAn /Cra k �.aroa n,nn Skft 54 Sw1 hor A"" slow *awl: kWN r F * Cast kM 961" (J01 LOW* lovem YMIW R" W low {atom Mate tk LOP W 11w0000tk (1f1 hdn Fast Slobs N I t /)Q 1999 H dronxxic' Pumps. Ashlonli, C�h o. AJ! R' Resawd. HYDRQMATIC w - You, Aulhor,zk Lo rd oi sn;buror - 1 840 Baney Rod AsNad, Chia 44105 isl: 419289.3041 Fix 419.2114011 Wig Sole: www.pnlalrpsmp.com SALES CIFFICIS IN All RAJOR CRIES AND COUNTRIES Q 'lam w. W02•0350 1406 SM �� U 1 � System Management Management of this system is critical. As a condition of approval of these plans this system management section must be reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber, T.L. Sinz Plumbing, 715 235 2644, or the St. Croix County Zoning Office, 715- 386 -4680, should be contacted for assistance. General Proper functioning of an on -site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or compartment to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. 1. If the septic tank is installed prior to sheet -rock and/or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. 2. Install water - saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. 4. Never pour grease or oil down any drain or stool. 5. Garbage disposals are not recommended; if you must have one, use it sparingly 6.. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. ' 8. Avoid surge flows of water; try to spread laundry throughout the week. 9. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans. 10. If septic or pump tanks are no longer used, they must be properly abandoned. 11. If construction timing and weather could create a frozen infiltration system, weather - proofing with plastic sheeting and heavy mulching may be required to maintain a functional system at start-up. Maintenance 1. The septic tank must be inspected every three years by a properly licensed person. 2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. 3. When the septic tank is pumped, any solids in the bottom of the pump tank must be pumped, and the filter must be back - washed into the septic tank to remove accumulated material. System use may require more frequent filter cleaning. 4. Periodic observation pipe inspections should be made by the homeowner to examine the state of the in -situ soil adsorption cell. Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. 5. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. 7. Avoid compaction such as vehicle traffic within 15' down -slope of the adsorption system. 8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run -off into the system area. 11. Warning: Do not enter septic, pump or other treatment tanks; death may result because they may contain lethal gases or insufficient oxygen. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, desi -nin-. and /or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 s �( Z(1;� y Wisconsin Department of Commerce SOIL EVALUATION REPORT p age 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code * County St. Croix Attach complete site plan on papei not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and parcel I.D. d 30 . ZO percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. R iewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m )}. Property Owner Property Location P Quest Development, Inc. Govt. Lot E 1/2 1/4 SW 1/4 S 25 T 30 N R 20 E r)a Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# Suite 150 10700 Old County Road 15 38 Birch Park City State Zip Code Phone Number ity nvllage ■ Town Nearest Road Plymouth MN 1 55441 ( 7¢3 -595 -9512 1 County Road E St losenh R New Construction UseE] Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material T .o ss over out wash sands Flood Plain elevation if applicable ` 1 - T General comments This site is suitable for a mound system. Additional borings may reveal a sit ilk le Tor a 6el ow' gra2le and recommendations: J ` conventional system. f Boring � .'�� ��,P1 X Boring # "'� ,L T C� g a pit Ground surface elev. ft. Depth to limiting factor > li n ate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bou a' Rb in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. �, ,'"; - *Eff#2 1 0 -9 10yr3/2 is lfgr mvfr cs �.7 1.2 2 9 -45 7.5 r4/4 s Osg ml cs if .7 1.2 _ 3 45 -86 10yr3 /2 sil 2msbk mfr - - .5 .8 - (P F 2 a g 9 Borin # Boring 37 ❑ 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/fP- in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -8 10yr3 /2 Is Ifgr mvfr cs 2f .7 1.2 2 8-37 7.5 r4/4 s 2msbk Osg cs - .7 1.2 3 37 - 10yr3/2 f2f5yr5 /8 sil lmsbk mfi - - .2 .3 * Effluent #1 = BOD > 30 _< 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = B 5 < 30 mg /L and TSS < 30 mg /L CST Name (Please Print) Signature CST Number Thomas C Nelson G 227387 Address Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond, WI 11/21/01 715- 246 -2454 Pro a Owner Quest Develbpment.Inc P rtY Parcel ID # Page 2 of 3 FTI Boring # U. Boring El pit Ground surface elev. ft. Depth to limiting factor >40 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 1 0 - 10yr3 /2 - Is Ifgr mvfr cs 2f .7 1.2 , 2 9 -40 10 r3/2 - s Osg ml - - .7 1.2 7 F -1 Boring # ❑ Boring Pit Ground surface elev, ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD- 8330Test (R.07 /00) ... . . Q r c � w S eon & o 0 'Z + % 87.10 103,60 r p2 91, 00 polo ti 03 99�r� Q � lot __ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT ' AND OWNERSHIP AND FORM OwnerB uyer �1 r- vo/ G ddress �' "� Mailing A � 70 leW Property Address —� ,� � r .J 0 c' 3 z TL" C3�o 7 r(�- (Verification required from Planning Department for new construction) ���5�L t,�p , Gd Parcel Identification Numbet - - - City /State Z- - go M0 • 10 4 Z LEGAL DESCRITTION Property Location W Town of '/4, Sec. N- I�____._ p Lot # � . Subdivision �` � 1� c Volume Page # Certified Survey Map # , r � Page Warranty Deed # Pa e# �� ��d�b Volume g -- Spec house ;A yes ❑ no Lot lines identifiable K yes ❑ no SYSTk:M A�IATNTEN . Proper maintenance ANC Improper use and maintenance of your septic system could result in its premature failure to handle wastes s e p tic consists of pumping out the s tic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of rho septic tank as a treatment stage in the waste disposal syst em. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a lumber, restricted plumber or a heensod pumper verifying that (1) the on -site wastewater disposal system s in mast oper operating jo tingond ( if n y), the septic tank is less than 1/3 full of sludge. is in proper operating condition and/or (2) after inspection and pumping I/wc, the undersign od have read the above requirements and agree to maintain the private sewage disposal system with the standards ent of Natural Resources, State of Wisconsin. Certification set forth, herein, as set by a Department of Commerce and the Department Office within 30 .st�tin8 ttiat� our tic has n maintained must be completed and returned to the St. Croix County Zoning days of tl?c throe a on e. J DATE NA APPLICANT' OWNER CER CAT O our knowledge. I (we) am (are) the owncr(s) of ( I that all statements on this form are true to the best of my (our) g the pro rty d e by vi c of a warranty decd recorded in Register of Deeds Office. DATE SIGMA IVRL OF APPLICANT 00040** Any information that is mis- represented may result in the sanitary permit be revoked by the Zoning Department. y of Deeds office Include with ran this application: a stamped warty deed from the Register a copy of the certified survey map if reference is made in the warmaty deed I :'Soo r 1 1 , 39 It STATE BAR OF WISCONSIN FORM 1 - 1998 K ATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS l : T •. CROIX Co., WI Document Number ' RECEIVER FOR RECORD I s�I��f� i�:2idtAl� This Deed made between _ Birch Par k, LLC a Minnesota li mit ed liab compa � WARRANTY DEED Grantor I REC PEE= 11. 00 and Delaney Company LLC ,; TRANS PEEL 5 9� 7 f -- - -- I COPY FEE: _�- - -- CC FEE: It PAGES: I - -- — - - - --- Grantee. Grantor, for a valuable consideration, conveys to Grantee the following t. described real estate in St • . Croix County, State of Wisconsin (the "Property "): RK.ording Atea Name and Return Address li t Premier Title Insurance Abenc 7300 Metro Blvd., #300 Lot 38, Birch Park Edina, MN 55439 { s 030 - - 21.27 -80 --000 i Parcel Identification Number (PIN) i fE This not homestead property. !i I (is) (is not) € 'i i f i; t. a i� Together with all appurtenant rights, title and interests. ,t 1: Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except i Ij Dated this day of January { ; f i Birch -- SEAL (SEAL) By : •` `'' ' °� ( ) t. Jantes Waters, s Chief Manager , (SEAL) (SEAL) f t; L i AUTHENTICATION ACKNOWLEDGMENT Signature(s) — State of WA hM Minnesotal l ' �; ! c< i� J . � Premier Title Insurance Agency Lot 38, Birch Park • !i 7300 Metro Blvd., ;'300 Edina, MN 55439 if i { i1 �I 030-- 21,27-80-000 j7 Parcel Identification Number (PIN) j ii This. i�' not homestead property. I (is) (is not) I j ;i it i, t i� 7� Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property Is good, indefeasible in fee simple and free and clear of encumbrances except !! j Dated this _�- clay of January Birc 7 t j a _ (SEAL) By : _ _ �sh ` —� . (SEAL) (i 4me.13 Waters, ef Manager _ (SEAL) (SEAL) i AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of VWLX6&&4M Minnesota VLS ss. w e ar. — County. authenticated this _ day of Personally came before me this day of January 2004 the above named1 — Ja mes M. Watera�, Chief Manse i Birch Park, LLC, a Mi limited lia bility company, on behalf of t TI'T'LE: MEMBER STATE BAR OF WISCONSIN limit lia company. -- -- to , (If not, _ me known to be tka, f, p e oing � authorized by §706.06, Wis, Stats.) instrument and ac4o,, WMIA sarp THIS INSTRUMENT WAS DRAFTED BY ( �^^ � +� � °(� (y �'yr'• � �Y r ;�, PyFt f � _ 7" r'S <: ;� . ..., ..... Ak 7 � +R x ro i s V _ p Notary Public, State of Wi o s In My commission is permanent. (If not state expiration date:ai (Signatures may be authenticated or acknowledged. Both are not (J ' necessary.) �^ ' Names of persons signing in any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. ; WARRANTY DEED FORM No. I — 1998 Milwaukee, Wis. 3/2/2004 6:57 PM FROM: 715 -531 -0630 Delaney Co. LLC /BC Builders LLC. TO: 1- 715- 796 -2519 PAGE: 001 OF 001 t ` + '+ + + k + P + } i� + +:. + + } + - :v E ,�s e 4 47/`i _ i lid 1 r I hmby certify that. this plate. was Pr ��� by Sole AS SHO't'�€ me 6r' under MY dWeCt' suporvision and that I Ohl ¢ duly Registered Professional Engineer Designed DJi -- : under the la the S #:ate of Wisconsii Crown A w cif - - -_ - -- Nome David Lash Dote 3/ Dote � - ---- -� _ T,. 3.�13�4t Checked �J1y Vp 0 32Z 1�1� 35.74' w fN LOT 3 rig $ f Alp \ / bi i s C) 1 LOT( "38 Ito Nib iff 1 � MML -dJ� r t� 1 � .�g o •i g SgJ•46`42 716.51, b�