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HomeMy WebLinkAbout030-2149-10-100 (2) ,Wi;consh Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix 5Nety and Building Division j" INSPECTION REPORT Sanitary Permit No: b 515000 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Tr Permit Holder's Name: City Village X Township Parcel Tax No: Sanocki, Steve & Maria I St. Joseph, Town of 030- 2149 -10 -100 CST BM Elev: Insp. BM Elev: BM Description: tt Section/Town /Range /Map No: 1Na L OJT 36.30.20.3035A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ..n CAPACITY STATION BS HI FS ELEV. Septic , Tr. t Benchmark 3.5 gab ,n Alt. BM Aeration Bldg. Sewer Holding SUHt Inlet ( 9 7 TANK SETBACK INFORMATION St/Ht outlet 477 ,1611 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 7 S d � Z 1 7 � / ^ Dt Bottom ` \ Dosing Header /Man. ��• 3G o• 5 7 Aeration Dist. Pipe /D. 9 '7 3 /2.3 ti/. Holding Bot. System / /.Cj Z 1 3 .3 + (o PUMP /SIPHON INFORMATION Final Gr \- Manufacturer GP and St Cover 2 � J Model Numbe TDH Lift Friction Loss System Head Ft Forcemain Lengt Dist. to Well �! SOIL ABSORPTION SYSTEM BED /TRENCH Width / Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer:�,�� INFORMATION Type Of System: CHAMBER OR ' 'S� UNIT Model Number: GEC ` N nul DISTRIBUTION SYS EM V7 Low.., V Header/Manifold Distribution Pip \ x Hole Size x Hole Spacing Vent to it Iny�[ce es) \ � \ \ 3 f o Length Dia Length � Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over t � Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center 7(� 1 Bed/Trench Edges Topsoil Nll_� '* Yes ❑ No ' — �r� Yes Q No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 253 123rd Ave Hud onn WI 54016 (NW 1/4 SE 1/4 36 T30N R20W) NA Lot 16 Parcel No: 36.30.20.3035A 1.) Alt BM Description = �'' `j Ga �.•�.. G� ti S �-- �d 6,� 2.) Bldg sewer length = Z I 47 - amount of cover = / o�-� 3 a �- 7- -j — Pl e other Re quired? 0 de for additional information. I U No SBD -6710 (R.3/97) Date Insepcto Cart. No. ke Vi si M cone ywce.wo.gov Safety and Buildings Division County �/ 201 W. Washington Ave., P.O. Box 7162 -5 Y n t rio ep $COn$i� Madison, W L , 11707 Sanitary Permit Number (to be filled inbYCo.) a rtment of Comnttlrene rj J j Ob� Sanitary Permit Application State Transac / lion Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate govermocnial A unit is required prior to obtaining it sanitary permit. Note: Application forms for state -owned POWTS are projact Address (if diffmnt than mailing address) submitted to the Department of Commerce. Personal information y vide may be used for secondary p urposes in accordance with the Privacy Law, s. 1 S.04(1 m Stats. 6Z U e I. A liention Information - Please Print All Information tl j c Y Property Owner's Name Parcel # D 3a, � l Y Q —�Q -- rQ(� RECEIVED Property Owner's Mailing Addfess Property Location / /FQ /,rlx �� l l�r `U e I i MO Govt. Lot � � (' 3 6 35A- City, State Zip Code Phone Number N Lr/ ' /., ' /+, Section ST. CROIX COUNTY (000r0 Tgo N, R ,,40 C]E W 11. Type of Building (check All that apply) -7 ` 1 or 2 Family Dwelling - Number of Bedraott� „� �/ Ellublic/Con nercial - Describe Use Brock City of ❑ State Owned -- Describe Use CSM Number ❑ Village of GU � t i 1- 7 11 / ' ! d4,a Town of _ d 5e, III. Type of Permit: (Check o iy one box on One A. Co mplete line B if li cablo) A. New System Replacement Treatment/Holding Tank Replacement Only F1 Other Modification to Existing System (ta*in) ---- -, system R. Permit ermit Revision Change of Permit Transfer to List Previous Permit Number and Date Issued Renewal Before Plumber New owner F.V iration IY. of POWTS S m/Com nent/Deviee: Cheek all that a Non - Pressurized In -Ground Lj Pressurized In-- around At -Grade Mound > 24 in. of suitable son Mound < 24 in. of suitable soli ❑ Holding Tank ❑ Other Dispersal Component (explain) OPredeattraers Device (explain) V. DispersalfIrrestment Area Information: i c 72 Design Flow (gpd) Design Soil Application t) D 1 Area Required ( Dispersal Area P System Elevation / f 7 Vl. Tank Info Capacity in Total # of Manufacturer Material Gallons Gallons Units n New Tanks EsxistingTmrks (/ a t / lok 525 Septic or Holding Tank Dosing Chamber V11. FppLa sibility Statement- I, the undersigned, assume respoa mAky for Iastaftom of the POWTS on the attaehed plain. Plumber's Name (Print) Plumber's Sigoatare Number Business Phone Number G k ek t2 Y d l Plumber's Address (Street, City, State, Zip Code) d 54 oo � .rJ Y O t ' VIMU-Conalty /De rtment Use Oa >0 pproved Penn it Fee Date Issued d Issui ctrl WSignatu $ (� !O 1-7 Qg 1X. Conditi w" aeons for Disapproval n- ' 1 ��• 1. Septic tank, effluent filter and 3) 1 ev. t I * D/L dispersal cell must all be servtces / maintained as per management plan provided by plumber. 2. AN't>s tockrequirements must be maintained apka ble code / ordinances. Mich to complete plena far the system and submit to the Con" G* On paper nor ku &ne s to s r 1 imehas 'now SBD -6398 (R. 01/07) Valid thm 01/09 4 1 l ECOPY ocr 4 - eyk"�' e � 66d h � 0 1 Wrsoonsin Department ot Commerce SOIL EVALUATION REPORT Page - Division of Safety and Buildings in acooMance with Comm 85, Wis. Co Attach complete site plan on paper not less than 8112 x 11 inches in size. Pla S - 1 include, but not limited to: vertical and horizontal reference point (BM), direction and 6 Z / percent slope, scale or dimensions, north arrow, and location and distance to n Date Please print all information. Re by Personal Informallon you provide may be used n aw, s, 5.04 (1) (m)). Property Owner P perky Location / ,� G Lot /V v�J 114 S L 114 T 3 Q N R (� E (or) � Lo # Block # Subd. Name or CSM# Property Owner's Maili g Address City State Zip Code Ph OFF ICE City C] Village "®Town Nearest R S�. GPD ® New Construction Use: [57 Residents[ / Number of bedrooms — — Code derived design flow rate Co 0 ❑ Replacement ❑ Public or commercial - Describe: ft Flood Plain elevation if applicable Parent material >J a Q General comments g j e ( v , og ,Bdo,,, ()o, (* u r and recommendations: Baring /- © Boring # Bo Ground surface elev. �;, ,S U n• Depth to limiting factor 1 �� In. Pit Soil on Rate icati on Texture Structure Consistence Boundary Roots GPD Horizon Depth Dominant Color Redox Description „ EfW1 „ Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. _ Z ) Z 30 /C S" rn S I V OS Yr\ L — 7 I/ [] Boring ❑ Boring # Ground surface elev. 9 � _ g• Depth to limiting factor _ ►n• Soil ion Rate ® Pit Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDItf E in. Munsell Qu. Sz. Cont. Color Gr. Sz. 5h. _ -,' I - , a C S I o -ro c 3/t - L , � *Effluent #1 =130D > 30 < 220 mg1L and TSS >30 < 150 mg1L * Effluent #2 = BO D < 30 mglL and TSS < 30 mg1L S' CST Number CST Name (Please Print) ature J S �c, YnU1 Date Evaluation Corlduded Telephone Number Address -5L 5 p iL i- a 7l '?6 42 -7 0 Property Owner Parcel 1D # Page Z of Z Boring # ❑ Boring Q S Pit Ground surface elev. (� S G k. Depth to limiting factor ZS in. Soil plication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 1 PDNF� in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. , tl L3� C5 Il !6 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in• Soil m Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *E GPD/f! In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Boring El Boring # k. Depth to limiting factor in ❑ pit Ground surface elev. Soil ication Rate Root P Horizon Depth Dominant CDior Redox Description Texture Structure Consistence Boundary *Eff#1 *EW2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * Effluent #1 = SOD, > 30 220 mg/L and TSS >31) 150 mg/L * Effluent #2 = BOD < 30 mglL and TSS < 30 mg& The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD -8330 (RO7100) PAQ V. � �,.QT# � i TION ,v c"'I�a Ili S T.2 N 70 E OR NAMIC SCA L 9M 1 ELtVATION /0 U OM t DESCRIPTIOR --- BM 2 ELIE VATION BM 2 D[SCMIPTION SY E LKVATIOM,., Lt S YSTItM TYPt ( CJdI u p ✓�� u�a� .. h \ K.e Q Z --- ----------- � �a1 s�clni DATE - - O commt®rce.tllil.gtsv Safety and Buildings Division County a 201 W. Washington Ave., P.O. Box 7162 "Mi „J� �y�+j <• $�� Madison, W1. 53707 -7162 Sanitary permit Number (to be filled in by Co.) gt a MptltMSflt t,ofnntsroe t Sanitary Permit Application state Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the Nry unit is required prior to obtaining a sanitary permit. Note: Application forms owned Project Address (ifdiffavat than mailing address) may submitted to the Department of Commerce. Personal information you provide be or purpo in accordance with the Privy Law, a. 15, ! m State. � 7 - 5 3 J Z3 (r� 1. A lication Information - Please Print All Informati Property Owner's Name : �.. , . b- Parcel # O 3� ! 7 U - y< 7 tiV �� Property Owner's Mailing Address Properly Location i pB.9 a Y � SEE d l zC t� , `v � Govt. Lot City, State Zip Code ph 1lLu b ; (_UuNTY W2 L r!i S" 6 8' ZOM! JG OFFICE IL O k � Type of BulkUng (check all that a ) Lot# T Q N isi1 or 2 Family Dwelling - Number of Bed v Block # - p f d .� ❑ PubliclCommercial - Describe Use �. VK i 4L )*.a 0� /0 City of ❑ State Owned - Describe Use ' 7 f f `C�SM Num ❑ Village of / ? Z tt5�— c.� �"� Gljkq. Y , ) i p. IRTown of tIl. Type of Permit: (Cheek only one box on late A. Core line B N applicabi A New System Replacement Tree olding Tank Only Other Modification to Existing System (explain) System List Previous Permit Number and Date Issued B. Permit Petmi► Revision Change of Permit Transfer to Renewal Before Plumber Owner 'C Expiration t IV. Type of POWTS S stem/Com nent/Deviee: Check ail that a Non•Piessurized In- Ground Pressurized In-10round U At Mou 24 in. of suitable soil Mourd < 24 in. of suitable soil Holding Tank Lj Other Dispersal Component (explain) Itmeftl Devi plain) V. DispenaVrreatment Area Information: Design Flow (gpd) Design Soil Application Rate( f) Di Area Required (sf) / Di 1 Anew S s System FJevadetn �6e ev Gil VI. Tank infn Capacity in Total # of Mm materia Gallons Gallons Units New Tanks Existing Tank [ Septic or Hooding r-k QQV Gtl� �j v Dosing Cbnmbu � i-e .JCS Y � i✓ CY'�Gc - "7 VII. Res assume Responsibility Statement- 1, the , as respoaslbnky for hedt8afioa of the POWTS fYe p Plumber's Name (Print) umber's Signature Number Business Number Plumber's Address (Street, City, State, Zip Code) VIII. Conn /De artment Use Only Issui art Si Approved Permit Fee Date I Owtra• Giv ea Denial S L /5/1 ' Ob 16 0$' IX. Coaditi8t r . sons for Disapproval v 1. Septic tank, effluent filter and dispersal cell must all be services / maintained as per management plan provided by plumber. 2. All selbackrequ►rements must be maintained - cadelaalinwas ANaeh to eomph" pleas for the systan red subadt to the Cerary sN9 ar PaM� °Ot than ti trs: t t is a is also SAD -6398 (R. 01 /07) Valid thru 01109 I� lie Q J � 4 4 5- C o a� cc c O PY e ti J v � �U 3 d f _ Lhonzo ED,r IVA S nSin Q I!� A ION REPORT Pa e 1 o #1363 Departmen of Commerce w Wis. Adm. Code g Steel's Soil Service, Inc. Division of Safety and Buil \ _ NTY County Attach complete site plan on p 1FI inches in size. Plan must St. Croix include, but not limited to: vertissa-poid(BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. Q ?jQ ' /Y Please print all information. Review By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 12 - 1 7 165 Property Owner Property Location Pirius, Terry t na 441/4, E1/4, S36, T30N, R 0 Property Owner's Mailing Address of # Block # Subd. Name or C 400 South 2nd ST. na Seven Oaks City State Zip Code Phone Number ity ❑ Village ®Town Nearest Road / v�/C /s Hudson WI 1 54016 1 715 -386 -0252 St.Joseph 125Th St ® New Construction Use: ® Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ❑ Replacement ❑ Public or commercial - Describe na Parent material Knolls of pitted outwash plains Flood plain elevation, if applicable na ft. General comments C onventional system system elevation 102.75ft. Trenches spaced and depth to code 3.00ft below grade. and recommendations: I F-1-1 Boring # 1:1 Boring ® Pit Ground surface elev. 105.75 ft. Depth to limiting factor 100 / 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 1 0 -8 10yr3/1 none sl 2msbk mfr cs is .6 1.0 2 8 -22 7.5yr4/4 none sl 2msbk mfr cs if .6 1.0 3 22 -37 7.5yr4/4 none ms osg ml cs na .7 1.6 4 37 -100 7.5yr4/6 none cos osg ml na na .7 1.6 r 11 3b Boring # ❑Boring ® Pit Ground surface elev. 105.75 ft. Depth to limiting factor 100 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 1 0 -8 10yr3 /1 none I 2msbk dfr cs 2c .6 .8 2 8 -24 10yr4/4 none sicl 2msbk dfr cs is .4 .6 3 24 -40 7.5yr4/4 none ms osg ml cs na .7 1.6 4 40 -100 7.5yr4/6 none cos osg ml na na .7 1.6 rr 3e Effluent #1 OD > 30 < 220 m /L and TSS >30 < '150 m /L Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L 9 9 — — 5 - - � 5 CST Name (Please Pr i t) Signatur CST Number David J. Steel 248956 Address Steel's Soil Service, Inc. Date Evaluation Conducted Telephone Number 99 0th St 4 20 .Baldwin WI 54002 7/27/2005 715- 760 -0347 SBD -8330 (R.07 /00) I f Property Owner Pirius, Terry Parcel ID # pending 1 Page 2 of 3 3 F-1 Boring 3 Boring # Pit Ground surface elev. 99.35 ft. Depth to limiting factor 100 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 1 0 -8 10yr3 /1 none sl 2msbk mfr Cs 1C .6 1.0 2 8 -23 7.5yr4/4 none sl 2msbk mfr Cs if .6 1.0 3 23 -42 7.5yr4/4 none ms osg ml Cs na .7 1.6 4 42 -100 7.5yr4/6 none Cos osg ml na na .7 1.6 If �r 3� F -1 Boring # F-1 El ❑ 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/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # F-1 B °ring ❑ 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 1ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 <150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS <30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) Steel's Soil Service, Inc. STEEL'S SOIL SERVICE INC 3of3 David J. Steel Terry Pirius 994 200" St. CST - POWTSM Ni.11 /4,SE1/4,S36,T30N,R20W Baldwin, WI 54002 Lic. #248956 Town of St Joesph, St. Croix Co. Direct 715- 760 -0347 Lot, X � C S M 2,-D Fax 715- 684 -3449 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of this test may or may not be as shown, as permanent lot lines were not established at the time the soil test was conducted. Legend N 1" = 40' = Benchmark Ele. 100.00 ft Top of 3/4" pvc pipe o = Alt Benchmark Ele. 100.90 ft ❑ Top of 3/4" pvc pipe = Borings Boring Elevations BI = 105.75 ft B2 = 105.75 ft B3 = 99.35 ft B4 = 0.00 ft I �o i 9525 aBsd TZ ToA zsol Z 30 L 133HS Nouvwao 3210W NOj 301dd0 JNINOZ ,11Nf100 X10210 '1S 3H1 10Y1N00 _ _ 'S3d0 - IS 3S3H1 GMMS10 Ol 03mn03N 39 I.YW 11W213d rmi �O� 10 - _ 3sn dNY"1 V 'SNOLLV - inO3H ONINOZ tlNnOO X10210 - -LS Ol - - - - -- 103rens 39 wri lVHl S3dOlS SNIVIN00 AIN3d08d SIHI MA �- �-�---- T1 R IO**9* M « LZ R ££.00S (3..£Z.94.ZON) TT S/ 9! .80•Z4Z ,£6•lI.Z W �9H II LQ ��a�o, x � 2�x ao GI QQmQ�` I I�it) I 'b QW�°�z \I I NN / . �m ~a i~ taJ� X :l :�O m °o W �" = 0 h^ — ep N w< I < J I �, 3 A I- r �QS� OW o i N I � I / �\ �QO W Q (.3 Az , AIn r 4 n uo) �I �i' OWO eQi Iuo,n ^o� o °I N r I F � k`' I Z -�"v�aoo I W W o zz ZE (A 3 a >< yaa z N v h ® d W Q �i�I I i p a 6� W J Ri x x x x ® Aso J, Q Z S. �� O ►- �I�i l / i � � O .�F� Z yy3JJ I W O (0 NQO 'Cl1l / / 6 � � rn sl v i s p .� a / / r it 3 O so rzt W a U 0 r ° v �� 0 M.OZ.O *.00S Z a ib �o W oOM 00 0 2 ZM�. - C-4 �W 022 ---- r7 a Qh NQ� s CL •� �� •0�+. $'��a �I o0 1 \W 4190 �9e $ ma �yy 9 O ~� 5 I d (/'1 O 8 C 1 •� 2� F- Z W I O I I (� 1 . 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V oil jry Al � 1 M ST. CROIX COUNTY, - SEPTIC TANK MAINTENANCE AGREEMENT AND y, r} OWNERSHIP CERTIFICATION FORM Ownerhgtiyor 1 1 I[:Lf 1-C. S4 r Mailing Address f l�C K-•}' 1 f� + r ' `✓ 1 r l l (,J c . ;� � r Property Address (Verification required from Planning & Zoning Department for new construction.) L C O 0 , ` Parcel Identification Number City /State -- LEGAL DESCRIPTION Property Location , t/a ,Sec.' , TN R.)—,D W, Town of Subdivision �� a J t.�� , , Lot #. Certified Survey Map # y - 7 1 , Volume Z . Page # 5 5 6 , Warranty Deed # , Volume , Page # Spec house yes �no Lot lines identifiable ye�sno SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system, Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master phmtber, 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 less than 1/3 full of sludge. I/we, the undersigned have read 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 Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my /our knowledge. I/we amlare the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms SIGNATURE OF APPLICANTS) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. •* Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) . _ _ . I IIII�I I�I�I I�III ��I�I �I�II I��II �I�I IIIIII IIII - * 8 II 8 0 4 'ff��JJ 7 1 2 STATE BAR OF WISCONSIN FORM 2- 2000 KATHLEEN H. WALSH < REGISTER OF DEEDS Document Number WARRANTY DEED ' ° ° �" ST. CROIX CO., WI RECEIVED•FOR RECORD THIS 'DEED -made. between Pirius Development Company,. LLC, 08%22/2008 ' 01: 50PM Grantor, and `-Stephen M. Sanoclu and Maria K. husband and Wife, WARRANTY DEED as Survivorshi . 'tal Pro Grantee. EXEHPi # p.M,an Prop erty, Grantor, fora valuable consideration, conveys and warrants to Grantee REC FEE: 13.00 the following described real estate in St. Croix County, State of Wisconsin: TRANS FEE: 438..00 PAGES: 2 SEE ATTACHED EXHIBIT A Recording Area Name and Retum Address: Edina Realty Title, Inc. 400 S. 2" St. — Suite 113 Exceptions to warranties: Hudson, Wl 54016 Easements, restrictions and rights -of -way of record, if any. 801957 030- 2149 -10 -100 Parcel Identification Number (PIN) This is not homestead property. Dated this 22nd day of August, 2008. Pirius Development Company, LLC * Ran Mirius, Member * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ST. CROIX COUNTY. ) ss. authenticated this 22nd day of August, Y! sro wn Personally came before me this August 22, 2008 the above named Ryan M. Pirius, Member, Pirius' Development c yj E c �I t i Company, LLC, to me Imown to be the person(s) who executed TITLE: MEMBER STATE BAR OF WISCONSIN the foregoin and acknowledged the same. (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY * Cheri Brown Notary Public, State of Wisconsin Peterson, Fram &Bergman — Steven H. Bruns My commission is permanent. (If not, state expiration date: 50 East Fifth Street, St. Paul, MN 55101 2/27/2011 ) (Signatures may be authenticated or aclmowledged. Both are not necessary.) *Names of persons signing in any capacity must be typed or printed below their signature WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-2000 EXHIBIT A Lot 16 of Certified Map filed Augustlb, 2006 in Volume 21 of Cgrtified Survey Maps, Page 5256, as Documenf Flo: 832288, located in part of the NE '/4 of the SW %4, Part of the NW '/a of the SE '/4 and part of the SW '/a of the SE '/ of Section 36, T30N, R20W, Town of St. roseph, St. Croix County, Wisconsin, being Lot 10 of the Plat of Seven Oaks. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner S� eptic Tank Capacity g al ❑ NA Permit # Septic Tank Manufacturer �'eS�s ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer 6 d 1-V k c c. J� C3 NA ETERS Number of Bedrooms ❑ NA Effluent Filter Model '�,� ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity Q a l ❑ NA Estimated flow (average g al/day Pump Tank Manufacturer sh ❑ NA Design flow (peak), (Estimated x 1.5) �"� g al/day Pump Manufacturer � +aA ❑ NA Soil Application Rate gal/day/ft' Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average" Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODJ 530 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade 0 Mound Fecal Coliform (geometric mean) 510` cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: 0 NA Other: 0 NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency At least once eve months) (Maximum 3 years) ❑ NA Inspect condition of iankls) ev ears) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cells) At least once every: 3 ear(th►s(s) (Me7dmum 3 yeast) ❑ NA / Clean effluent filter At least once every: monthle) 0 NA ear(s) Inspect um every* 0 year( )(s) ❑ NA Ins p p pump controls &alarm At least once eve «�-- ' ❑ Flush laterals and pressure test At least once every: monthO ❑ NA ^ — 0 years) ❑ month(s) 0 NA Other: At least once every: 0 year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank actions must include ude a visual p ' I i al ins action of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. i i START UP AND Oi?iERATION Page Of For new construction, prior to use of the POWTS A004 00#0r it 4041 fir the presence of paintin Products or other chemicals that may impede the treatment process and /or darn s I, gp 4 s iPl {yi Ihigh con centrations.are detected have the contents of the tankls) removed by a septage servicing operator `_tt . System start up shall not occur when soil condition ye surface. During power outages pump tanks may fill above )itfrfIi1 K �� Shen power is restored the excess wastewater will be discharged to the dispersal cells) In one large doilli�'rf d may result in the backup or surface discharge of effluent. To avoid this situation have the conteAt$ df x } p .by a Septage servicing Operator prior to restoring Power to the effluent pump or contact a Plumber pif lWrtt�f b assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispe ".0011i, t {yq o spark over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grads 4011 tt+ d iii A, Reduction or elimination of the following from thi, w rsl1 Rld+� )prov the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts) �1;3 ;) degreasers; dental floss; diapers; disinfectants; fat; foundation drain lsump pump) water, fruit and �,,. Q'i grease; herbicides; meet scraps; medications; oil; f painting products; pesticides; sanitary napkins; tairi��} ABANDONMENT When the POWTS faits and /or is permanently takeh +Ili# d$ tli+� °iegll steps shall be taken to insu►e that the system is properly and safely abandoned In compliance with 0119ot ppnsin Administrative Code: • All piping to tanks and pits shall be disconhi(ptdral d 4 b1tl i Pipe openings sealed. • The contents of all tanks and pits shall be 0 Aiiitl �r}piliy dl#sS►sed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be k>�i Mlid d tgyg0 Or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN if the POWTS fails and cannot be repaired the folltfl 4 d MOO $V0 b+1en, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been avlllet MIT. {{ for the location of a replacement soil absorption system. The replacement area should be p11);i f# �'Mr H1 f�l>l'1 I Il19(1 Ond compaction and should not be infringed upon by required setbacks from existing and propoi) X` wells. Failure to protect the replacement area will result In the need for a new soil and sit ble replacement area, Replacement systems must comply with the rules in effect at that time." ❑ A suitable replacement area is not availltl +'4 �dk 11il� /Pr soil limitations. Barring advances in POWTS technology a holding tank may be installed dl } � q r(flrl�rl .the failed POWTS. The site as not en evaluated to identl> El llf y area. Upon failure of the POWTS a soil and site evaluation be performed to locate a stY{t tf no rep lacement area is available a holding tank may b ail s a last resort to replace lily!, efl�itl < , } I in place following removal of the biomat at the Ll Mound and at -grade soli absorption syst infiltrative surface. Reconstructions of such OV4tt}llbifii4hy Wit the rules in effect at that time. < <WARMNO> > SEPTIC, PUMP AND OTHER TREATMENT TANKS ENTER A SEPTIC PUMP OR TRE ATMENT. AN�IOR INSUFFICIENT oxYaE DO NOT OTH ER EATMENT ' . R" TANCEO. DEATH MAY RESULT. RESCUE F T UE O A PERSON FROM THE INTERIOR OF A TANK MAY BE ADDITIONAL COMMENTS �, , , yypl Rll T7 �IUMI PDWTS INSTALLER A Nam Phone ?,•�" _ .3 S --31 a 1 1+llili SEPTAGE SERVICING OPERATOR (PUMPER) 1YATORY AUTHORITY Name I Iur 5f . GC'l Zort( A cf Phone This document was drafted in compliance with chapter Comm ll<440(4b)i III dlit4(fl dnd 1.!.A 4(1 t. (2) at (3). Wisconsin Administrative Code. SEPTIC TANK 6 PUMP CHAY.BER CROSS SE CTION AND SPiC:It ltjtllltty� 41f CI' VENT PIPE `12 "I #N. ' AS OVE GRADES WEATHERPROOF ? 25' FROM D OOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOL / OVLOCER FINISHED GRADE -- WARNING LABEL 4" CT RISER 4" MIN. IS" IN. 6 MAX. INLET i WATER TIGHT' SEALS JGAS-; ' T IGH T � � PROVED A SEAL 1 JOINTS WITH PPROVED j--- + ALM APPROVED PIPE I PE 3 ` —�. � � + ON 3 ' aL�� SOI L NTO SOLID If OIL PUMP OFF ELEV . .._..__ .FT. OFF P � RISER EXIT PERMITTED ONLY D IF TANK MANUFACTURER HAS APPROVAL 3" APPROV BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER! Sir NUMBER DOSES PER DAY: TANK SIZES SEPTIC GAL. DOSE VOLUME INCLUDING DOSE 1 GAL" FLOWBACK: 1 GAL. ALARM MANUFACTURER: CAPACITIES: A = INCHES =GAL. MODEL NUMBER: 2 INCHES= 32„ GAL. SWITCH TYPE; 2&c rr ---- PUMP MANUFACTURER: C = _ INCHES = GAL. � �+ � ,.._.. MODEL NUMBER : a D = INCHES = SWITCH TYPE: M-err ..�- REQUIRED DISCHARGE RATE _A_ GPM PUMP E ALARM WIRING AS PER ILHR -16.2a WAC ,� FEET VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE " -�-, FEET + MINIMUM NETWORK SUPPLY PRESSURE . • . • " " a " . . ` " " FEET + _4 FEET FORCEMAIN X ,14 - — IOfl F TOTAL I DYN MIC " _ l 7 FEE R TE INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WTDTHT�____,_+ DIAMETER LIQUID t SIGNED: LICENSE NUMBER �?,�?7��t'G DATE: �.--- �� � _L.l 1/88 [qGOULDS PUMPS Submersible Effluent Pump EPO4 if 3871 EP05 APPLICATIONS • Fully submerged in high ■ EP05 Impeller. Thermoplas- ■ Bearings: Upper and lower Specifically designed for the grade turbine oil for tic enclosed design for heavy duty bail bearing following uses: lubrication and efficient improved performance. construction. • Effluent systems heat transfer. ■ Casing and Base: Rugged • Homes Available for automatic and thermoplastic design provides AGENCY LISTING • Farms manual operation. Auto- Qmdm standards nssodation superior strength and corrosion • Heavy duty sump matic models include resistance. • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end • Dewatering assembled and preset at the for efficient heat transfer, in "F" or "C ".} factory, strength, and durability. SP ECIFICATIONS ■ Motor Cover. Thermoplastic Goulds Pumps is ISO 9001 Registered. FEATURES cover with integral handle and Solids handling capability: FEATURES switch attachment points. 1 /4 " maximum. ■ EPO4 Impeller: Thermoplas- 0 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 NPT. seal protection. • Mechanical seal: carbon - rotary/ceramic- stationary, BUNA -N elastomers. • Temperature: 104°F (40°C} continuous Rs FEET - 140 °F {60°C }intermittent, _1111._ -.. _ _1111 • Fasteners: 300 series 10 _ .. _......_.4 stainless steel. y 30 - _1.111.. ' __1111__ ______. —► *2 sGPM r._. • Capable of running dry without damage to a Fr components. 25 ...... -. _ Motor: I 1 x • EPO4 Single phase: 0.4 HP, v 6 201 ___ -_._ _ �..._ _ _ _ r _ _____. -.�__ 115 or 230 V, 60 Hz, 1550 5 RPM, built in overload with I ' automatic reset. a 4 p 1111 .. i....... 1.111.. 111...1.. ._ .. ............ • EP05 Single phase: 0.5 HP, o EPOS I 115 V, 60 Hz, 1550 RPM, 3 1 o il .,. _.._ 1111_ built in overload with ... ! EPO4 _111.1... . ..... -. automatic reset. 2 • Power cord: 10 foot 5 :1111 standard length. 1613 1 ... ...... ._ SJTOW with three prong grounding plug. Optional 20 0 00 . 10 Z ........ 30 _ . __� _ ._ . __... _.. _... GPM foot length, 16/3 SJTW with three prong grounding plug ' (standard on EP05 ). 0 2 4 6 8 10 12 m /h caPnciTv Goulds Pumps ® 2000 Goulds Pumps ITT Industries Effective February, 2000 83871