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HomeMy WebLinkAbout032-2137-20-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 4793$4 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal infontiation �7ou provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Boyd, Chris I Somerset, Town of 032- 2137 -20 -000 CST BM Elev: Insp. BM Elev: + BM Description: Section/Town /Range /Map No: 0 W 02. (ad O Z- _ 13.30.19.1214 TANK INFORMATION ELEVA I N DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic Benchmark + (�.� (6�tLi2_ l2.SD I�f •3o D2. goo Dosing U Alt. BM l750 ��� �� JI0 •ZAf Aeration Bldg. Sewer )c o t Holding SVHt Inlet T .�o g,g Jo$. 1 0 + TANK SETBACK INFORMATION St/Ht Outlet . 3 d Jo�•c�o TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System 1 •'fb� f z. S Final Grade PUMP/ IPHON INFORMATION Man acturer Demand St Cover S. o ' a s So' �,, •� Model Nunlr TDH Lift n Loss System Head TDH Ft Fo main Length Dia. ist. to Well SOIL ABSORPTION SYSTEM r2 2 Width r Length f No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. FLiquidDepth DIMENSIONS 3 12 SETBACK SYSTEM TO P/L l" BLDG IWELL LAKE /STREAM LEACHING Manufa r: INFORMATION CHAMBER OR Type Of System: UNIT Model Number. -- 6A13 6AShk - DISTRIBUTION SYSTEM Heade r /M ikid Distribution x Hole Size Hole Spacing Vent to Air Intake �. Pipe(s Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems On Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil I Yes [] No Yes r� No COMMENTS: (Includ co dis nci / p present, etc.) Inspection #1: OK • 0Z I 2 ( 4 5 Inspection #2: --- f -- "' 7 ' Locat 1580 1 84th St New Richmond, W (NE 1/4 NW 1/4 13 T30N R19W) Stonewood Lot 12 Parcel No: 13.30.19.1214 1.) Alt BM Description 2.) Bldg sewer length - amount of cover Plan revision Required? Yes L] No Use other side for additional tinformat 1 l Date Insepctor's Signature Cart. No. SBD -6710 (R.3/97) �CQ Q O Safety and Buildings Divist Coun 201 W. Washington Ave., P.O. Box 62� �� , C�� vi a - 162 Sanitary Permit Number (to e filled in by Co.) Department of Commerce ( �E1VED Sanitary Permit Ap 1ic 9�� State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, perso al infoftat'fonidu .9rAW5 maybe used for secondary purposes Privac Law, sl5.04(1)(m) Project Address (if different than mailing address) ST. C � 01 X - h cul 1A AMC I. Application Information - Please Print All Informati HNG 0FnCj s8D 8 1-f 5T_ Property Owner's Name Parcel # Lot # Block # C � cs & 1A AZ Property Owner's Mailing Address Property Location City, ��h'3 Co L� Zip Code / Phone Number � �� °, ^'&' �� °> Section (circle one) N; R�E or W II. Type of Building (check all that apply) oQr c , Y 1 or 2 Family Dwelling - Number of Bedrooms �(a f ubdivision Name �1 , QCSM Number El Public /Commercial - Describe Use wD �" ❑ State Owned - Describe Use ❑City ❑Village Wownship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) O 3 Z - 213 Zo - '060 C Z 2 4 A. V New System ❑ Replacement System ❑ Treatmem/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Chan g e of 11 Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner 7 0 r M4_ 7 _ 0 1 2M* /'1kJrJ All A IV. Type of POWTS System: Check all that ap 1 f VNon - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Ceeaching Chamber ❑ DriELjW ❑ Gavel -less P e ❑ Other (expl ) V. Dispersal/Treatment Area Information: 2 f ' AA A064910 Design Flow (gpd) Design Soil Application Rate(gpdsf) ispersal Area Required (sf) Disp al A ea Proposed (sf) System Elevation b� . 7 SS 8 8 ° I IU .�S VI. Tank Info Capacity in Total Number Manufacture Prefab Site Steel Fiber Plastic Gallons Gallons of Units w' 6 Concrete Constructed Glass New Existing i{yn Tanks Tanks Septic or Holding Tank t l Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) f,, F- Plumber's ' nature MP/MPRS Number Business Phone Number 4 k l ZZ ym `y/Tr PI mber's Address (Street, City, State, Zip C e) ra l D 1I` W !• G 3Q VIII. County /De artment Use Onl Approved ❑ tsa ed Sanitary Permit Fee (i ludes Groundwater Date Issued 1 suing ent Signature o Stamp Surcharge Fee) s) A El iven Reason or enial IX. Conditions o ppro 1/Re SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be sgrviced / maintained as per management plan pawided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size i SBD -6398 (R. 01/03) r i 'p " S t t' • �; ;_ K i r i i N 4 i Ul_ WK jr MA W f G A s R • y R ? t 40 sagoW46 515.76 • i f Y � �r . ' 31 w T i ar N i t wk SSn4! ,t (6 Fall r ft4 "ammommom ;8914!04*W 41196 wisconsin 17 ;artment of Commerce SOIL AND SITE EVALUATION MvWon of and Buildings Page of Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. # 1 APPLICANT INFORMATION - Please i�iZ° 7 R iewed by Date Personal information you provide may be used for se ndai ¢urposes*vac Law, }5. (1) (m)). yL`g Property Owner If i erty Location r . Lot 1/4 1/4,S �� T ,N,R E (ortq Property Owner's Mailing Address t Block :7 Name or CSM# I - T C ^tX Tom( City State Zip Code Phone, �, Nearest Road Ci Village �, Town � �J New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement El Public or commercial - Describe: O Code derived daily flow r � gpd Recommended design loading rate � �bed, gpd /f? 4 trench, gpd/11 Absorption area required ASR bed, ft 2 �_ trench, ft Maximum design loading rate > bed, gpd /ft gpd/ft Recommended infiltration surface elevation(s) / /B, RS It (as referred to site plan benchmark) Additional design /site considerations f Parent material 1221 Flood plain elevation, if applicable A, I a ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system J21 S❑ u © S ❑ U 9 S ❑ U I as ❑ U I ❑ s ® U ❑ S 5 U SOIL DESCRIPTION REPORT Boris # Horizon Depth Dominant Color Mottles Structure GPD/ft Boring Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench �I j Ground 3 .7 elev. l kt.63t ' Depth to limiting factor / &,/—in. Remarks: Boring # 1 + •S Ground elev. f Depth to limiting factor n. Remarks: CST Name (P Print) Signature Telephone No. : � � �' Address / Date CST Number �� < < 3 PROPERTY OWNER ., SOIL DESCR REPORT Page of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench �S - s y Ground el l ev. ,y� Depth to limiting factor Remarks: Boring # :-r .:::t ifLd - r / �- Ground elev. Depth to 3 limiting factor 3, in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. 1 14 Depth to 3. Z ' limiting ; factor ) in. Remarks: Boring # Ground elev. tt. , Depth to limiting factor in. Remarks: SBD -8330 (R.9/98) - - -_ - - ��/;�his ft� _- - - a - -- POWTS OWNER'S MANUAL AND MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS Sep tic Tank Ca ci 1 0D O NA Owner e v tic Tank Manufacturer w� c f [3 NA Permit # Effluent Filter Manufacturer o co ❑ NA DESIGN PARAMETERS Effluent Filter Model Qto -w ❑ NA Number of Bedrooms 100 room ❑ NA p Tank Ca city gal GkNA Number of Commercial Units Pump Tank Manufacturer ANA Estimated flow (average)* bpo aVda Pum Manufacturer ANA Design flow (peak), estimated x 1.5* 9OOgal/day Pum Model E!(NA Soil Application Rate gal/day ft Pretreatment Unit SZNA Influent/Effluent Quality (NA❑) Monthly Average ** ❑ Sand/Gravel Filter ❑ Peat Filter Fats. Oil & Grease (FOG) < 30 mg/L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BODs) < 220 mg/L ❑ Disinfection ❑ Other: Total Suspended Solids (TSS) Manufacturer: Model: < 250 m Dispersal Cell(s) Pre treated Effluent Quality ❑ Monthly Average * ** �"- ground (gravity) ❑ In- ground (pressurized) Biochemical Oxygen Demand (BODs) < 30 mg/L ❑ At - grade ❑ Mound Total Suspended Soliers (TSS) { 30 n�g/1. ❑i�ie ❑Other: r Manufacturer Fecal Cofiform (geometric mean) < f 10 c i/.100m1 aching Chambe Model Q t c k- y Laying Length/Chamber 1 2 Maximum Effluent Particle Size 1/8 inch diameter Soil Application Rate— 2 Area Req. _a5_ - � *Wastewater Flow verb cation and Calculations: (Other than bedroom based) Infiltrative Surface/Chamber -ESIA Rating Minimum Number of Chambers N$ ❑ Aggregate Design Flow/Loading Rate= ft mm ** Values typical for domestic (non - commercial wastewater Materials: all materials must comply with WI Aden Code COMM84 and be installed per manufacturers specifications and septic tank effluent and a al letters. ** *Values typical for retreated wastewater. roy DESIGN CRITERIA ❑ "Wisconsin At -grade Soil Absorption System, Siting, Design & Construction Manual" (Converse etal.1990) ❑ "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and E.J. Tyler. Publication 15.22 ❑ "Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems" Publications 9.6 ❑ "Design of Conventional Soil Absorption Trenches and Beds". 8J. Otis - ASAE Publications 5 -77 and "Design Manual - Onsite Wastewater Treatment and Disposal Systems ". EPA 62511 - 80-012 October 1980 ❑ SBD - 10570 -P (8.6/99) "At -Grade Component Manual Using Pressure Distribution" ❑ SBD - 10567 -P (86/99) "In Ground Absorption Component Manual" ❑ SBD - 10705 -P (N.01101) "In Ground Soil Absorption Component Manual" Version 2.0 r3 SBD - 10628 -P (N.6/99) "Recirculating Sand Filter System Component Manual" ❑ SBD - 10656 -P (N.6/99) "Split Bed Recirculating Sand Filter System Component Manual" ❑ SBD - 10572 -P (86/99) "Mound Component Manual" ❑ SBD - 1069.1 -P (N.O1 /01) "Mound Component Manual" Version 2.0 ❑ SBD - 10595 -P (86/99) "Single Pass Sand Filter Component Manual" ❑ SBD - 10657 -P (8.6/99) "Drip -line Effluent Disposal Component Manual" ❑ SBD - 10573 -P (R 6/99) "Pressure Distribution Component Manual" ❑ SBD - 10706 -P (N.01 /01) "Pressure Distribution Component Manual" Version 2.0 ❑ Drip -line Effluent Dispersal Component Manual for Multi-flo Onsite Wastewater Treatment Units ❑ MAINTENANCE AND MANAGEMENT MAINTENANCE MONITORING SCHEDULE Service Fre uenc Service Event um 3 Inspect condition of tank(s) At least once eve ❑months Years) pum out contents of tanks) When combined slud a and scum uals one -third (1/3) of tank volu �� 3 ) In t this rsal cell(s) At least once eve ❑months ld ear(s) (Max► Clean effluent filter At least once every 6 0 months [I earls) In ct m , ump controls &alarm At least once every ❑ months ❑ year(s)A Flush laterals and ressure test At least once every ❑months ❑ ear(s) �` N Valves At least once every ❑ months ❑ year(s) .� NA Other: At least once every ❑months ❑ year(s) P ge of START UP roducts or other chemicals that For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting p may impede the treatment process and/or damage the dispersal cell(s). if high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. OPERATION its. The The property owner is responsible for the operation and maintenance of the POWTS and submission of required repo Quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water- saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume_ Also the brine or waste from waT& softeners, iron removal tints, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetablelfruit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non-biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. ❑ Valves Valves shall be operated in the following manner: ❑ Alarms Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service. POWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back -up of sewage into the dwelling or surfacing. INSPECTIONS Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). ❑ Septic Tanks Component Tank inspections most include a visual inspection of the tank 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 backup or ponding of effluent to the ground surface. Access. openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one -third (1/3) 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 NR113, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according tto�ufa� is at specifications. Provisions are to be made to retain solids in the tank. Filter cleaning frequent intervals than stated in the maintenance schedule to keep the system Operating— [I pump Chamber/ Treatment Tanks Component such as pumps, alarms and floats. A visual check must be The inspection must include a test of all electrical equipment made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of any filters. Any service needs or repairs shall be promptly taken care of. Xn -Ground Gravity Component Dispersal Cells in the observation tubes and a visual inspection for any The inspection shall include recording the levels of ponding, if any surface must be promptly reported to the regulatory evidence of surface seepage or discharge. Any discharge to the ground indicate overloading or impending authority. Ponding at depths greater than 75% of the height of the component may hydraulic failure necessitating more frequent monitoring. Page_ of ❑ Mound, At- Grade, In- Ground Pressure ndin if any in the observation tubes and a visual inspection for any The inspection shall include recording the levels of po g f surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory evidence o authority. f surfs g greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The pressure distribution system is provided with an opening at the end of each lateral to be used for flushing. The laterals should be flushed at least once every three (3) years Pressure checks of systems with multiple laterals should be done to ensure that equal distribution of effluent is occurring to promote the longevity of the system - REPORTS tion, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Reports for maintenance, inspec Code. ABANDONMENT When the POINTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. COMM 83.33, Wisconsin Administrative Code. - All piping to tanks and pits shall be disconnected and the abandoned pipe openings seal. Th co itl s of all tanks and pits shall be removed and vroperly dLTv -0 of by a Se?�tage Selvic:ng Operator. After pumping, all tanks and pits sbali be excavated and removed or their covers removed and the void space filled with soil, gravel or other inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: `'�\ A suitable replacement area has been evaluated and maybe utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance an d compaction and should not be infringed upon by required setbacks from existing and proper stricture, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil from existing and Proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil an d site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. p due to setback and/or soil limitations. Barring advances in POINTS technology a A suitable replacement area is not available S holding tank may be installed as a last resort to replace the failed POWT- failure of the POINTS a soil and site evaluation E3 The site has not been evaluated to identify a suitable replacement area. Upon must be performed to locate a suitable replacement area If no replacement area is available a holding tank maybe installed as a last resort to replace the failed POWTS-- may p Mound and at - grade soil absorption systems be reconstructed in Place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT II ATANKS O 1 R C,rREANiENT G ASSES AND/OR INSUFFICIENT ANY CIRCUMSTANCES. OXYGEN. DO NOT ENTER A DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFF][Ci3`i T O IMPOSSIBLE. ADDITIONAL COMMENTS POINTS MAINTAINER POINTS INSTALLER Name d Name �- H Phone 71 s 76A • e l2 Lphonv 5 LOCAL REGULATORY AUTHORITY SEPTAGE SERVICING OPERATOR (Pam r) r P�hone genc S , c � Name IS — 3 86 5'68 Phone K: \WPDATA\EII\POWTS OWNER'S MANUAL - Page of -- ST. CROIX COUNTY SEPTIC TANK MAItdMANCE AGREEMENT AND 11 \\ OWNERSHIP CERTIFICATION FORM Owner/Buyer �hrtswd Mailing Address / , / Z3 Property Address ISS B S (Verification required from Planning .Department for new cowu=tian_) City /State I Parcel Identification Nwaber J A GAL nESC r-T IQ Property Location )J`z 'la , n1 0 _ Ala , Sec. 3 , T N R )9 W, Town of _ Sw•� Subdivision _ w , Lot #. Certiffed Survey Map # 'Volume , Page # - Warranty Deed # _ �7_ � � �� s Volume , page # z C, Spec house yes no Lot :roes identifiable yes no SYSTMMAINTENANCE Improper we and maintmance of your septic system could result in its prenumn failure to Sandie wad. Proper maintenance consists afpumping out the septic tank every three years or sooner, if needed by a licensed pumper. Wbat 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(l) and in Chapter 12 - SL Croix County Sanitary Ordistmm The property owner agrees to submit to St. Croix C,euwty Zoning Depu m mt a certification farm, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumW verifykg that (1) the on sitz wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if aeeesmy), the septic tame is lass thi,15 foil of sludge. Ylwe, the undersigned have read the above requir+etaents and agree to maintain, rise private sewage disposal system with the standards set fnrdr, herein, as set by the Deputment of Commerce and the Depa aunt of Natural Reaoumcs, State of Wisconsin Certification stating that your septic system has been maintained must be completed and returned to the st. Croix County Zoning Department vii 30 days of the year expiration crate. C TGNATURE OF APPLICANT DATE QMWER _RTIFTCA ON Uwe citify that all s n rm ta on this fa are true to the best of my/our knowledge. 71we amlare the owner(s) of &e Property 'bad ahov . warranty decd recorded in Register of Deeds Office SIGNATURWF APP LICANT DATE Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning Departu =t. ''**• *• Include with this application a stamped warranty deed firms the Register of Deeds Office and a copy of &e certified survey map if reference is nWe in the warranty deed. �,.� ���� � ������ �`� "'�. +e � ® °- �� __�__ , '� r � 1 ���, .� _ �� � �.�, �� i j N I'� `" �._ ,, r, n r` �-- ��, .9. 7 I � J f �.J........,.., _, ('. T O "' L _ � /r 'l. � � `J ^ � � `77 `'� � � � �, ,r o c:' _ o � :� i- .�t y } � O ;, U. 2778 P 067 7914 KATHLEEN H. WALSH DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1 -1982 REGISTER OF DEEDS WARRANTY DEED ST. CROIX Co., WI S RECEIVED FOR RECORD THIS DEED made between Alicia Sandy and Paul A. Sandy, Wife and 04/05/:2005 01:16PR Husband ( "Grantor ") and Christopher M. Boyd, A Single Person ( "Grantee "), WARRANTY DEED EXERT li REC FEE- 11.00 WITNESSETH, that the said Grantor, for valuable consideration conveys to Grantee COPYSFEE: 170.40 the following described real estate in ST. CROIX County, State of Wisconsin: CC FEE: PAGES: 1 Lot 1 , Plat of Stonewood, Town of Somerset, St. Croix County, Wisconsin. RETURN To ►y23 kAPRVL_ c,4n,v pt•r t Eia� 1 I W %0A. "17 Tax Parcel No: 032 -2137 -20-000 This IS NOT homestead property. (is)(is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And Alicia A. Sandy and Paul A. Sandy warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except Easements, restrictions, and encroachments of record. and will warrant and defend the same. Dated this I st day of Anril. 2005. (SEAL) (SEAL) * *Alicia and (SEAL) 1 (SEAL) * * Paul A. Sandy AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN SS. I authenticated this 1 s� day of Aori1. 2005 ST. CROIX County * Personally came before me this 1st day of April, 2005 the above TITLE: MEMBER STATE BAR OF WISCONSIN named Alicia A. Sandy and Paul A. Sandy to the known to be the (If not, persons who executed the foregoing instrume y► • 'edge authorized by § 706.06, Wis. Stats.) the same. ^ �••�� cif. THIS INSTRUMENT WAS DRAFTED BY Rick L. Pendergast * Er .0 J _ r Q ,t `• ERIC P. Notary Public C Attorney -At -Law My Commission is permanent. (If not, state j ion date: (Signatures may be authenticated or acknowledged. Both are not q ` iT O 6 ) .• .q R PJ necessary.) •• ''�*..w...N'' r *Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED File # 05000660 900 Visiw Form SDD03WI Rev. 01/16/96 CROSS SECTION OF A TRP-NC14 SYST WIT14 LEACHING C14AMBER. `/a Slope System Elevation 1 IO fit, Of U ihls Trez 6b Width Trench Ler�,til "9.a _ .ft. — final Grade Elevai:ion \0'7 A % Slope system Elevadg IfQ - A " 4 Of Uftiiq .23 Tr6ach Width ft Trench tengtEi Fins) Grad Bivvariou ' ID �1 ft. T'�NCH3 slope f T airs Tr �, nch 'V idth it _ Trench Leiikh ft - Fh l b2d Grade Elevation ft SOIL ALL MUST BE A. MAIM M OF 12 INCHES Qs,? -ER THE TOP OF THE CHAIMBEF- EAcJJ, NCH MUST CONTAIN A VENT A /dk AN ssEpmk PEE AT SACH END. PLLF1vIB *R ')<C►j+ NIT/Ne1•~s ✓ R d�L� 1 ?� DAT ADDITION INFOI M:, TION.- €d Wti6z : 6o sooz E • I nt 'ON XUA WCF6A Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Building Division INSPECTION REPORT Sanitary Permit o: X0 (ATTACH TO PERMIT) 086 0 GENERAL INFORMATION State Plan ID Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Sand , Paul' I Somerset Township -20 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range / 3.30.19. 1 44 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet � TANK SETBACK INFORMATION SUHt Outlet TANK TO I P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header an. Aeration VFinal Grade ipe Holding ystem PUMP /SIPHON INFORMATION Manufacturer Dem St Cover GP Model Number TDH Lift Friction Li: m Head TDH Ft Forcemain Length ist. to Well SOIL ABSORPTION S YSTEM BEDITRENCH Width Length o. Of Trenches PIT DIMENSIONS Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO APIL JBLDG IWELL LAKE /STREAM LE \UNI Manufacturer: INFORMATION CHA Type Of System: Model Number: DISTRIBUTIO SYS TEM Header /Manifold Distrib n x Hole Size x Hole Spa a Vent to Air Intake Pip Length Dia I LaMth Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Ed Yes No �+, >J Yes I No u COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: ! / Location: 1580 84th St Somerset, WI 54025 (NE 1/4 NW 1/4 13 T30N R19W) Stonewood Lot 12 Parcel No: 13.30.19. 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes No Use other side for additional information. �_ _ _ — -- SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. Safety and Buildings Division County ` � m 201 W. Washington Ave., P.O. Box 7082 �s seonsin Madison, WI 53707 - 7082 Sanitary Perini Number & filled in by Co.) Department Of Commerce (608) E�C, l V ; D 300 �p Sanitary Permit Applicati in State I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal informati4 n you pr�Igv� ? may be used for secondary purposes Privacy Law, s15.04 1 xm) l Address (iVdiffeurent mailing address) I. Application Information - Please Print All Information S.� Property Owner's Name Parcel # t # / Block # Property Owner's Mailing AddrCss perry _ tion % Section /3 City, tate `T�— --� Zip Code Pho Num r G circle o N; R E ory II. Type 6f Building eck all that apply) w e G6�t- Alnmber , ❑ 1 or 2 Family Dwelling - ber of Bedrooms t, Subdivision Nam ❑ Public/Commercial - Describe ❑ State Owned - Describe Use X &k 1Z. S ❑City ❑V i lage ip of LS�e III. Type of Permit: (Check only on ox on line A. Conflete 11 If ap b A. New System ❑Replacement tem Trentm olding cement ❑Other Modification to tin ZFA XList 7 27"De Lssued B• ❑Permit Renewal ertnit Revision hange of P Before Expiration her er AV IV. Type of POWTS S tem: Check all at appI Non - Pressurized In- and ❑ MouA ab and < ble ❑ At- gle Pass Sand Filte Constructed Wetland Pressurized In -Gding Peat Fi ❑ Treatment U rculating Sand Filt 6,0 Recirculating Synthe Media Filter r ine Gravel- th V. Dispersal/Trejment Area jillaftation: 1 7 14 > ; Design Flow (gpd) Des' p 77p 7 7ation Rat e(gp ersal Required (sf) is sed 40 Syst eva . Tank Info Cap ac' in N anufacturer fab S Fiber Plastic ns lowAr o nits Concrete Co ted Glass New Existin T Tanks Septic or Holding T O F Aerobic Treatment Um Dosing Chamber VII. Respo sibility Statement- I, the un igned, assume responsibility for installation of the WTS shown on the attached plans. Plum 's acne rint) Pl ber' Si a e MP/MPRS Number Business Phone Number 5 5 Plumbers Address (Street, City, State, Code) / ZV VIII. Coun /De artment Us nl Approved ❑ Disapp/Ven Sanitary Permit Fee (includes Groundwater Date Issued sui Agent Signa re o Stamps) Surcharge Fee) ❑ Owner Reas on for Denial Z.Z S Zo 0 - IX. Conditions of App al/Reasons for Disapproval C14 LAk Attach complete plans (to the County only) for the system on paper not less than 81/2 z l l Inches In size SBD -6398 (R. 08/02) s / # i : . * � . r / « s N*0004 �« Y 3 � i f : I Z -- r — I r—r - I , r- - -- — } —r - —� i-- ' - -- -- - - -- �- - - - -- - I I i I - 'Z t : I i I I ' �- --- �-- +— _'�- - -� � 1 • —__��— �— _t - - "�— — r '- �-- � �-- _�_— �___�. —_�_ _ —te r- -- - - -r-- r'— �I--}— �_._ I >nrx 4,1 let t POWTS OWNER'S MANUAL. & MANAGEMENT PLAN Page"/—of FILE INFORMA ON SYSTEM_ S PECIFIC_ ATION_ Owner . . , I Septi g o NA Permit # QC1 Se tic T Manu facturer v ❑ NA Effluent kilter Manufacturer &') a NA DESIGN PARAMETERS E ffluen t kil ter Model ❑ NA Number of bedrooms ❑ NA Pum 'Tank Capacity al ANA Number of Commercial Unit ONA Pump Tank Manufacturer p Estimated flow (average) T g al/day Pump Manufacturer ANA Design flow (peak), (Estimated x 1.5) g al/day Pump Model qtNA Soil Application Rate gal/day/ft' Pretreated Unit Influent /Effluent Quality Monthly Average* ❑ Sand /Gravel filter ❑ Peat h"ilter Fats, Oils & Grease (FOG) <30 nag/L r -t Mechanical Aeration a Wetland Biochemical Oxygen Demand (BODs) <220 mg /L ❑ Disinfection ❑ Other: Total Suspended Solids (TSS) e 150 mg/L Manufacturer Quality Pretreated Effluent ❑ NA Monthly Average ** Dispersal Cell(s) Q y � In- ground (gravity) o In- ground (pressurized) Biochemical Oxygen Demand (BODs) <30 mg/L ❑ At -grade o Mound Total Suspended Solids (TSS) <30 mg/L ❑ Drip-line ❑ Other: Fecal Coliform (geometric mean <10 cfu /100mL Maximum Effluent Particle Size '/s inch diameter * Values typical for domestic (non - commercial) wastewater and septic tank effluent. ** Values typical for pretreated wastewater, MAINTENANCE SCH EDULE Service Event Service Frequenc ns ect condition of tanks At least once every ❑ months ears Maximum 3 rs) OtImp out contents of tanks When combined sludge and scum equals one third '/7 of tank volume ns ect dispersal cells At least once every ❑ months ears Maximum 3 rs) 'lean effluent filter At least once ever ❑ months - 'd year(s) ns Wct pump controls & alarm At least once every _ u months u year(s) ANA 'ush laterals and pressure test At least onc cve r�� i r months ❑ year(s) ANA )thee At least once every cl months ❑ year(s) izNA )(her: I At least o nce every ❑ months o year(s) ANA 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; POWTTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal 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. � hen the combined accumulation of sludge and scum in any tank equals one -third (' /s ) 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 ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatment components, and any other maintenance or monitoring at intervals of 12 months or less shall he performed by a certified POWTS Maintainer. A `crvicc report shall be provided to the I0ca1 rei;ulutory authority within 10 days of completion of any service event. START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that my impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tanks(s) removed by a Septage servicing operator prior to use. Owner: 6 ,2 Z Page '2of System start up shall not occur when soil conditions are frozen at the infiltrative surface. (wring power outages pump tanks may fill above normal high water levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact. The area within 15 feet down slope of any mound or at -grade soft absorption are. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONEMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with ch. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage servicing Operator. • After pumping, all tanks and pits shall be excavated and renuived or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: '2 / A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect'the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. o A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. o The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. o Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at the time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLEi POWTS MAINTAINER Name N ame Phone - _ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Na Phone Phone S - 5 JUN -02 -03 12.16PM FROM -Best Software, Inc. Corp, Comm, 949753805' T -826 P.01 /01 F -681 ST CIWIX C009TY SEPTIC TANK MAMMANCA AQR=L ONT AND; OWIMRSID aRTMATION FORM pwaer/8uyer X.1 On 1A Nsaiiin /S�'• ���'� property Addxtss � m fcariou from Plaaaing epartuseat zUV a satrctiota) ty/State parer;! Idantihcation Number property Location '/, r /a Sec. , R 1N. Tawa of LNG M subdivision Certified Survey Map # " Volutue pag # Warrau ty Diced # , ' - id tif�a�Ye yts ❑ ]u�cs; eu Spec house 0 yes alp T` AM g S end mainteaanccof our septic systems,eoasld result &a its pramaturc fazilursto baadfo wastes. Props z mainteasnee " x a liceasod puutpGr. What you pert into %WM rhos aorWiiati of pumping out the saptic W* 0\►GtY �� Y.G� OX TOOACi..1f � ilOGdad by . can affect the function of ft septic tautic as'a'traatmient etSga &n tYie ovs�te dsapesaal SY�e.... pro ow= a8�a to submit to St Croix Zoo ag DePaz at a catioa forma; signed by the owner a=id by a =Stotpiumber, jou=ymaapl=bcr, rmtrictedplurnber or a liCceascd pumPl" vecit�riotg that (1) the oa - site w8st "Mm . o tug conditioa, aad/or (2),,atTrx ios�cu�zn and pautisltsg .(,if.nas�s�aY. Y_�R �Pf p tic is .. I I t6aa in full of elufte. with the sta Vwc, *c twdmigaed bane read the above rogviieioeats artd agiee to malttLairi gTC'piivatG sewage disposal syotux► atcds set forth. b=64 as set by tha Dapartment'of Camsrierce and tiYe.Depiac�pameat of patiucsrRosortrtiec,`Stat� of W Lace o a � c wi 30 W A septic system ha3 been s ` iatsiticd alust be cainpleteiiand tciW�isSt. Croix Couaty Zoninexpintiors data.DATE APPLI ,SWN�rR CEO CA'TIbN_ sus ary the oymet(s) of I (we) certify drat a11� Statamena on t� foziri tua truss tb th+a bcsi of say {our) b►owledge: i (we) { ) d ver by virtue Of s w tj+-aced recordr.4ln,U6iatcref Deeds OQzcsa. DATE SIG A p CAlri Au infa atioa that is ris 4vpmwnod may ra'sult ilu'the saaita{y 'peralit b S; tvYolu by the Zoning papartarent• m « «, «„ •s «see y . ; oi'i s oft a ,. .. . «s xnclsueie with this application:'$ stso>�ad^ara r�ntyY'de9d izifrn;itle =Reg a capy of rho eOrtiw swan utap . it t1FYerw.rsce Is mach in rho warraaty deed lbl mc) Po - ?->!5 STA BAS t9F7VIDCf0NS�I �M 1 -1998 6 9 m 5 8 9 WARRANTY DE D REGISTER OF DEEDS ST. CROIX Co., WI Document Number RECEIVED FOR RECORD Thls•Deed, made between Hermle Enterprises. I.I.C. a Limited 09 -16 -2002 2:45 PH Liability Company! Grantor, and Alicia (�; Sandy and Paul :A Sandy, wife and husband , Grantee. WARRANTY DEED Grantor, for a valuable consideration conveys to Grantee the following EXEMPT M described real estate in St. Croix County State of REC Wisconsin(the "Property"): TRANS E FEE- 148 COPY FEE: CERT COPY FEE: PAGES: i RecordIna Area Name and Return Address Andy WM�0.,1 � V %aul Sandy omerset, 540.2R &"� 111, 4 �.�1J J t��• i �l� - 1 Parcel Iden�flcs 1 Nuumber ( IN) This Is not homestead property. Qs) (Is not) Lot 1 , Plat of Stonewood. Together with all appurtenant rights, title and Interests. None Grantor warrants that the title to the Properties good, Indefeasible In simple fee and free and clear of encumbrances except Dated this W day of September. W2. (SEAL) (SEAL) ermle Enterprises, LLC - (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(,) R ; r �� State of Wlseohsin, i OF WWSOMS. " St. Croix County authenticated this day of Personally came before me this AW day of Aj&te ?02 the above named Hermie Enterprises. LLC. a Wisconsin Limited Liability • m n . to me known to be the person who TITLE: MEMBER STATE BAR OF WISCONSIN execut the ping Inatru and acknowledge the (If not, same. / authorized by §706.06, Wis. Slats) % �y+� THIS INSTRUMENT WAS DRAFTED BY Coldwell Banker Bumet Notary Public, Stat of Wisconsin 1301 Coulee Road Hu 1 54016 My commission is permanent. (lf not, state expiration date: -39209 2furesmay be authenticated or acknowledged. --r-- 9 !� Both are e ry) �• necessary.) r 4n Yl 1 j A _ U� ) " Names of persons sloning In any cap acity must be tVDad or rim alt ed below their signature. t STATE BAR OF WISCONSIN Wisconsin Legal Blank Co, Inc. WARRANTY DEED FORM No. 1 -1998 Milwaukee, Wis. L o W 3 N 4q. 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