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032-2181-09-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County St. Croix Sat; ty and Building Division INSPECTION REPORT Sanitary Permit No: 515299 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: King, Jason Somerset, Town of 032 - 2181 -09 -000 CST BM El v: Insp. BM Elev: BM Description: Section/Town /Range/Map No: S 9 ! S 0 Ld�o� 41 2 01.31.19.1533 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS LEV. 5.7 /057 3 0. Septic - Benchmark llJ7� l.ZS 16.1 99. Dosing � � � Alt. BM Aeration BI . Sewer V4" k , slug o! �7 / d s" 901 Z Holding SuHt Inlet /0 St/Ht 06flet TANK SETBACK INFO TION TANK TO P/L EL BLDG. Vent to Air Intake ROAD Dt Inlet / ltie M �tk- 4►fWJ� Septic > so / > / f / I v Dt Bottom ,q Dosing Z / Head L � � Aeration - Dist. Pipe l + L� r r7 Holding Bot. System :W PUMP /SIPHON INFORMATION G� Final Gr Manufacturer Demand Co r E GPM Model Number TDH Li Friction Lo System Head TDH Ft �S 2. 5 2s��5 Forcemain Len Dia. /i Dist. to 11I S SOIL ABSORPTION SYSTEM BEDITRENCH Width Length / No. Of Trench PIT DIM IONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS O SETBACK SYSTEM TO PIL 5 1 BLDG IWELL LAKE /STREAM ACHING facturer. INFORMATION Ty Of System / CH BER O D Model Number: DISTRIB SYSTEM Header nifold /Distribution x Hole Size x Hole Spacing V o it Intak -- n/ Pi e(s) Z.S Z.S3 / fkm Lengt Dia r Length "� Dia J' S Spacing SOIL COVER x Pressure Systems Only xx Mound Or At Grade Systems Only C ` Depth Over Depth Over xx Depth of - xx Seeded/Sodded jxxx Mulched Bed/Trench Center Bed/Trench Edges Topsoil "�1 l• Yes �u No Yes Q No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: 1 / 7 -V I /V Inspection #2: / / Location: 2333 76th Street NNe , Richmond, WI 54017 (NW 1/4 SE 1//4,11 T31 R1 9W) W0000dla Meadows Lo 9 arc l No: 01.31.19.1533 1.) Alt BM Description = r/ f, `�, `<-S� � Vau-_ / ke / L� t� dd,}, 4-t) `� �f- 2.) Bldg sewer length / �d - amount of cover � Z � U Plan revision Required? 0 Yes VNo �// �I Use other side for additional information. �_I �G !�! —J SBD-6710 (R.3/97) Date Insepctor's Si ature Cert. No. I' Cmerce.Wl.gov Safety and Buildings Division County 201 W. Washington Ave., P.O Box 7162 St. Croix so n s n Madison, WI 53 — 7 Sanitary Permit Number (to be filled in by Co.) m of comrrterrtt e 5 15 Z Sanitary Permit Application �°° -�-- State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental / D / ZZd Z unit is required prior to obtaining a sanitary permit. Note: Application forms for state are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information r sec 2333 76 Street ses in accordance with the Privacy Law, s. 15.04(1)(m), Stats. I. Application Information — Please P rint All Information Property Owner' a e a a 1 a Parcel # 032 - 2181 -09 -000 Jason Kin V Property Owner's Mailing Address Property Location 866 Highview Dr. ST. CROIX COUNTY r Al" ✓hj PLANNING & ZONING OFFICE Govt. Lot City, State Zip Code Phone Number NW y.,SF- v, Section 1 4 WI 54016 T31N; R19 W (circle one) II. Type of Building (check all that apply) D3 In 01C Lot # ®1 or 2 Family Dwelling - Number of 131 Subdivision Name "�- 9 Plat of Woodla Meadows Public /Commercial - Describe Use Na City of State Owned - Describe Use J / CSM Number ❑ Village of 5 k / 6 Na ® Town of Somerset III. Type of Permit: (Check only one boa on line A. Complete line B if applicable) A. New System Replacement F Treatment/Holding Tank Replacement Only FJ Other Modification to Existing System (explain) System B. 17 Permit Permit Revision L1 Change of Permit Transfer to List Previous Permit Number and Date Issued Renewal Before Plumber New Owner Expiration I Q,57 7 5 IV. Type of POWTS System/Component/Device: Check all that a t Non - Pressurized In- Ground H Pressurized In- Ground ❑ At -Grade Mound > 24 in. of suitable soil Z Mound < 24 in, of uitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) / 44 f V. Dis rsal/Treatment Area Information: Design Flow ) Design Soil A lication Rate(gpdsl) Dispersal Area Requir A) Dispersal Area Propo (s System Elevation 450 1.00 /� 450.00 sq. ft. I Z J 450.00 sq. ft. �� 101.33' @ 19" above T / ` 3 99.75' contour VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units ��pp New Tanks Existing Tanks / / L 5 -2 Septic or Holding Tank 1000 1000 W ieser oncrete Dosing Chamber 650 650 1 Wieser Concrete 1:1 El CT VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signatur MP/MPRS Number Business Phone Number Bill Schumaker Cc1�L/�� 227990 715 386 - 3121 Plumber's Address (Street, City, Slate, Zip Code) 1070 Scott Road, Hudson, WI 54016 VIII. Coun /De artment Use Onl ved — PerriJ.� Date Issue Issuing t Signatur Owner eason for Der 1 $ IX Conditions of AppprovalfReasons for Disapproval f S ,STEM c V1NER: 3 1. Septic tank, emUartt fiker and ' dispersal cell must all be services / maint ained „� t'� �- �✓/ �f ;M,'t� as per management plan provided by plumber. Z.. All sstback requitstttents must be maintained as pa Owl Attach to complete plamz for the system and submit to the County only on paper not kss than 8 in z 11 inches in size �XrS inU �r4 t(el! • /oea �e ���d��y She 2333 76M" 6ic4� L.o & 9 014 t010 wood �( wyWSEyy r 0 T . o.�'Sornei'se -L� S�.4'oix C'e. tom%/ 8` Gz6. Y P ��poSed m cu,.�da..� ,u.76 x / /o.s8` �-y5'X 9o' .2 s " C-.,to4r; 7—wo C`�� d,'strf 6 r E: cry c 6 /lSe "x /,/. 28'w/ %B'o�r�ccs Sfrett o osed d��U Pro �a.�aye. .J 63 Pi-o�wsR.d 6 1 0� 6 edroo.w c '6 ,g' �QeS ace 1/"_ �`•. Y`:sc..l.. fit, P.J. p a b Q} �� pe" WTescd &;ncrcf e -9— w[P arao�lo5 -Afe co bo. SrlR cC, uY • lyLeX �°L- S.2Se,4Jaea�R /Eck 2 "54CA.�lo�J.C. �- rrr • n 60.39' �QCcUi / coo0w, .Y Safety and Buildings ' 10541 N RANCH ROAD commerce HAYWARD WI 54843 Contact Through Relay It isconsin www.commerce.wi.gov/sb/ g www.wisconsin.gov Department of Commerce Jim Doyle, Governor Aaron Olver, Secretary July 14, 2010 CUST ID No. 227990 ATTN: POWTS Inspector WILLIAM C SCHUMAKER ZONING OFFICE SCHUMAKER PLUMBING ST CROIX COUNTY SPIA 1070 SCOTT RD 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/14/2012 Identification Numbers Transaction ID No. 1812202 SITE: Site ID No. 757813 Jason King Please refer to both identification numbers, 2333 76TH St above, in all correspondence with the agency. Town of Somerset St Croix County NW1 /4, SETA, S1, T3 IN, R19W FOR: Description: Mound, 3 bedroom residence Object Type: POWTS Component Manual Regulated Object ID No.: 1271158 OW Maintenance required; 450 GPD Flow rate; 17 in Soil minimum depth to limiting factor from original grade; Sys�s diti Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01101), Pressure Distribution Component Manual - V �� 2.0, SBD - 10706 -P (N.01 101), SSWMP Pub. 9.6; Effluent Filter I rk P P il The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes DEPARTN! PP DIVI5IUN 0 �A and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code SEE CORRE 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: Key Item(s) • 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. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to P g P g service the filter shall terminate at or above finished grade with a watertight cover. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. WILLIAM C SCHUMAKER Page 2 7/14/2010 ' • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. • Maintain well and waterline set backs per COMM 83.43(8)(i). Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 L Balance Due $ 0.00 Patricia L Shandorf POWTS Plan Reviewer, Integrated Services WiSMART code: 7633 (715) 634 -7810, Fax: (715) 634-5150, M -fr 8:00 - 4:45 pat.shandorf @wisconsin.gov X cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 828-5902, Monday, 7:00 A.M. To 3:30 P.M. Notice: Starting July 1, 2009, no person or entity may engage or offer to engage in construction business in Wisconsin unless they hold a Building Contractor Registration, or equivalent, issued by the Safety and Buildings Division of the Wisconsin Department of Commerce. "Construction business" means a trade that installs, alters or repairs any building element, component, material or device that is regulated under the commercial building code, chs. Comm 60 to 66, the uniform dwelling code, chs. Comm 20 to 25, the electrical code, ch. Comm 16, the plumbing code, chs. Comm 81 to 87, or the public swimming pools and water attractions code, ch. Comm 90. The term does not include the delivery of building supplies or materials, or the manufacture of a building product not on the building site. For further information, go to our website: www.commerce.wi. Gov/ SB/ SB- BuildingContractorPro- ram.html I MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: King 3 bedroom residential mound Owner's Name: Jason King Owner's Address: 866 Highview Dr., Unit D New Richmond, WI 54017 Site Address: 2333 76th Street Legal Description: NW1 /4 SE1 /4, Sec.1 T.31N., R.19W. Township: Somerset County: St. Croix Subdivision Name: Woodland Meadows Lot Number: 9 Block Number: NHS. ovally Parcel I.D. Number: 032 - 2181 -09 -000 D Plan Transaction No.: ; F coM MF�CE Y AND UILDI GS Page 1 Index and title Page 2 Data entry SpON CE Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications 1 g� 2,ZC`2� Page 6 Management and contingency plan 1 Page 7 Pump curve and specifications Page 8 Site Plan Page 9 Attached soil evaluation report Designer: Bill Schumaker License Number: 227990 Date: 06/12/10 Phone Number: (715) 386 -3121 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706 -P (N. 01/01) i Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 83 -44 -3 in -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) coliform of - 36 inches. 450.00 Design Flow (gpd) 3.00 Site Slope ( %) 100.25 Contour Line Elevation (ft) 17.00 Depth to Limiting Factor (in) 0.40 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 90.00 Dispersal Cell Length Along Contour (ft) = 5.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd /ft 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (C or E) c Center or End Manifold 2.50 Lateral Spacing (ft) If N above, enter the elevation (ft) 4 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) 2.50 Estimated Orifice Spacing (ft) = 6.25 ft /orifice 2.00 Forcemain Diameter (in) 150.00 Forcemain Length (ft) Does the forcemain drain back? Y 83.00 Pump Tank Elevation (ft) Enter Y or N A 18.33 System Head (ft) x 1.3 24.47 Forcemain Drainback (gal) I b5' Vertical Lift (ft) 56.42 5x Void Volume (gal) Friction Loss (ft) 80.89 Minimum Dose Volume (gal) 0.00 In -line Filter Loss (ft) 29.66 System Demand (gpm) 27.68 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia, o tions choice in. dia. options choice 0.75 1.25 x x 1.00 x 1.50 x 1.25 x x 2.00 1.50 x 3.00 2.00 x 3,00 x Gallons /Inch Calculator (optional) Treatment Tank Information 646.00 Total Tank Capacity (gal) 1000.00 Septic Tank Capacity (gal) 38.00 Total Working Liquid Depth (in) Wieser Concrete Manufacturer 17.00 gal /in (enter result in cell B49) Dose Tank Information Effluent Filter Information 646.00 Dose Tank Capacity (gal) PolyLok Filter Manufacturer 17.00 Dose Tank Volume (gal /in) PL -525 Filter Model Number Wieser Concrete Manufacturer Project: King 3 bedroom residential mound Page 2 of 9 , . Y Mound Plan and Cross Section Views T 1/ 10 B nn J Observation Pipe I K O n A W 1: I B . .. .. I L -- Mound Component Dimensions A 5.00 ft E 20.80 in H 1.00 ft K 10.29 ft B 90.00 ft F 9.25 in z 9.90 ft L 110.58 ft D 19.00 in G 0.50 ft J 7.86 ft W 22.76 ft 450.00 (ft 2 ) Dispersal Cell Area 1341.35 (ft) Basal Area Available 5.00 (gpd /ft) Linear Loading Rate 9.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 103.60 (ft) —♦ G H t ,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,; , ...................... F Dispersal Cell 102.33 (ft) Lateral 101.83 (ft) --* — Invert er I sa Cell P Dis Elevation D }...� ,® 100.25 (ft) Contour Elevation 3.0 %Site Slope Geotex i e a rlc over Shading Key $' Dispersal Cell See lateral details on 17 `� Topsoil Cap c 1.5 ft ❑ Page 4 for number, size, 20 ,;;; Subsoil Cap w o 5 and spacing of laterals. © ] ASTM C33 Sand Laterals are equally v Z F spaced from the m 0.5 ft Typical Lateral ® �~] Tilled Layer c a distribution cell's Aggregate o centerline in the A distribution cell (AxB). � r T I Project King 3 bedroom residential mound Page 3 of 9 Center Connection Lateral Layout Diagram Force main oonnocWn „Ha tee or cross to mm"Id at &" p*W. Lsterals are identical P S •=Turn- upwiballvslwor IE.X�� x12 d2 laterals& force main of PVC Sch40 cleanoutpluo per COMM Tabk 54.30 -5 Holes drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.125 in Lateral Diameter 1.25 in Orifice Spacing (X) 2.53 ft Lateral Length (P) 44.28 ft Orifices per Lateral 18 Lateral Spacing (S) 2.50 ft Orifice Density 6.25 ft /orifice Lateral Flow Rate 7.41 gpm Manifold Length 2.50 ft System Flow Rate 29.66 gpm Manifold Diameter 1.25 in Total Dynamic Head 27.68 ft Forcemain Velocity 3.03 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Comm Electrical as per NEC 300 and - -� 16.28 WAC 4 in. min. Disconnect Tank component is properly vented MFo Alternate outlet location diameter Wieser Concrete Manufacturer 2 in. Cap acityl 646.00 Gallons Volume 17.00 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 19.24 327.11 B 2.00 34.00 C Pu off elevation (ft) C 4.76 80.89 84.00 D 12.00 204.00 D Total 1 38.001 646.00 D� ose tank elevation (ft) 3" Bedding uncler tank. 1 83.00 Alarm Manuafacturer LevelArm Alarm Model Number I DLV Pump Manufacturer JGould Pump Model Number 13885 WE05H Pump Must Deliver 29.66 gpm at 27.68 ft TDH Project: King 3 bedroom residential mound Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name Bill Schumaker Phone (715) 386 -3121 POWTS Reguiator's Name St. Croix County Zoning Dep't. Phone (715) 386 -4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1000 gal Maximum TSS 150 mg /L Soil Absorption Component Size 450 ft' Maximum FOG 30 mg /L Type of Wastewater Domestic Maximum Fecal Coliforml >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and /or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Inspect for ponding and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm, Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished ••....•.....••. ............... Grade 6 -8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: King 3 bedroom residential mound Page 5 of 9 J Mound System Management Plan • Pursuant to Comm 83.54, Wis. Adm. Code Qan®ral This system shall be operated in accordance With COMM 82 -84 Ws, Adm. Code, and shall maintained in accordance with its' component manuals [SBD- 10691 -P (N.01/01), SSWMP htjblidation ®.G (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD - 10706 -P (N. 01/01)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis, Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD 150 mg /L TSS, and 30 mg /L FOG for septic tank effluent or 30 mg. /L SOD,, 30 mg /L TSS, 10 mg /L FOG, and 10' cfu /100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. I (aO.ULDS PUMPS Submersible Effluent Pump 3885 � PROSURANCE AVAILABLE FOR RESIDENTIAL APPLICATIONS. ■ Shaft: Corrosion - resistant Single phase: ■ Bearings: APPLICATIONS 9 P 9 Upper and stainless steel. Threaded • Built -in overload with lower heavy duty ball bearing Speci?ically designed for the design. Locknut on three phase automatic reset. construction. ing uses models to uard against • All single phase models g 9 9 P In Power Cable: Severe component dut; onent dama e on feature capacitor start P 9 P rated, oil and water resistant. accidental reverse rotation motors for maximum Epoxy seal on motor end ■ Fasteners: 300 series starting torque. provides secondary moisture stainless steel. 9 'A and 1 12 HP — 16/3 SJTOW barrier in case of outer jacket ■ Capable of running dry with 115, 208 and 230 Volt damage and to prevent oil without damage to three prong plug. wicking. Standard cord is 20 • _ffluent s,�st� ms components. ' '3/ HP — 14/3 STOW with Optional lengths are available bare leads. ■ Designed for continuous Three phase: ■ O -ring: Assures positive SPECIFICATIONS operation when fully • Overload protection must sealing against contaminants submerged be provided in starter unit. and oil leakage. Pump •' /r2 HP — 14/4 STOW with • Ic1 h�lrci!laq capabilities bare leads. MOTORS AGENCY LISTINGS • Dl�charye size 2 NPT. ■ Fully submerged in high ■ Designed for Continuous �p to 140 GPM grade turbine oil for lubrication Operation: Pump ratings are Tested to or 778 and ' T o , c's r` and efficient heat transfer. within the motor manufacturer's C5A 22.2 108 standards nea� u�, to 128 feet - recommended working limits By Canadian5tandards ■ Class B insulation. ic us Asso r »per a t ure can be operated continuously Fiie J7rR38549 r 40 C' continuous without damage when fully 140 F 160 Cl intermittent. submerged. Goulds Pumps is ISO 9001 Registered •�� _r :1�r ^.unbers on METERS FEET s co iof specific HP, o 130 sae i.,Se .lnd RPM WE15HH - ',SERIES. 3885 120 SIZE 'h" SOLIDS S - - -� RPM 3500& 1750 0, WE20H ► SGPM FEATURES 30, too SFT 90 wE15H ■ Impelle clot � semi- °a 2s. r t v lth pump -out = 80'ZZ 0H _. .. � :l ,,,rc,. I seal � To �anlca a 20. H caldnced for i 60 W; tlhahY_L Silicon ° WE05 moeii - 0 40 E0 I cr available as -- __ a 5 1 Al WE 03M . I .Z. 30 11 Caslr past 'z l!CIer)cy, yp e �U• 20 L Casin Iron volute t r �' :SCharge �, 0 W E03 ■ Mechanical Seal: SILICON °o o zo 0 40 so 60 Soso 90 loo 110 1 CARBIDE VS. SILICON 20 130 140 DSO 160 GPN1 CARBIDE al;rlc faces. — 1 -- - - � 0 `i 10 15 20 25 30 'S 111 )Ieel metal parts, q i�Yllih'I.�t��/ APACITY /arc ��qu ;�eaC Goulds Pumps ITT Industries w�NSti youlds COW ��. 709 0 So// �dcc/ u4Ldn�p� EXiS��nq gr4de elzi^ • /oca t G4/ L.c� 9, �I �tw/�ysEt'y, see h oc. /. �-a3z- z�8/ a9_ G24. y8 , h��Cpose� y�ou.ndn.t Z�.76 X / /o /�. .2 5 Cntozr Ti-- (�t-) c3651t1'i ch P /'e posul �.7ell 7 (l S�rect e Pao a s`d dr'Ue �artuJIL .J ,o s C3 61 3 b edroor" A o of 6. �Q¢S id�ack. p — �� b a: ld,' Sewai CP P /'o�+0 xd W iQSCf' Nr,nc ✓ � w[ 1"coo165 -"ff Co-�o. ST�PC. p�, t3 2- 4 �•..YfolylaX PL'S�Se�"laaa�,� /� #?d.c. Tv r CG MQ.v� 60, 39 ft 'y 5%�C:sheliv: / 000odid W : Tai oFt'- ��rr1Lf� ( al�t�t Se E a{ 9 i'a ale (rve-(. 5 IS _ o., o_r_y ar Zc - -g Wisconsin Department of C,�`��® IL E VALUA T ION REPORT Page 1 of 3 DMs1on of salary and Bulflrga In a000rden. with Brie Cod County SL.Croix Attach oomplats sit n paper noblesa than 81 x 11 Inchea In size. Plan must of emcal and horizontal role nce (13M�d Pr+roel I.D. Pendia r slorm, north arrow, and o d estro Id. Revbwed Date ae print ah info +rtl fT Ci'WIX WuNT' Per■onol InroRnstl you PWI rM t» used for second■ u fvjd (� 04 (1) ( )• °�� Property Owner Property Location ■ AHRH Properties LLC Govt l.ot NW 114 SL 114 S I T 31 N R 19 E (or) VV Property owner's MallingAddreas lot# Blodk# Subd. Nerve or C8M# 404 SGreen Avenue 9 - woodland Meadows City Zip Code Phone Number ak milage Usr Newaat Road New Richmond I WI 54017 7f5- 222 -0169 CTH New Construction UseE] Residential 1 Number of bedrooms 3 t04 Code derived design flow rate 4 to GPD Replacement Q Publlo or oommerrlel - Describe; Parent material Locss over glacial till_ Flood Plain elevation If applicable "A i ft General comments Site suitable fora around system U der 0j 0a and recommendations: /° (--j Bohm * 13 BotSng L ` Pit Ground aurfaoe elev, 100.82 ft Depth to limiting factor 31-40 In. gap Application Rate Horizon Depth Domtnent Color Redox Deaoription Texture Structure Consistence Boundary Roots QEDM in. Muneell Qu. Sz Conk Col" Or. Sz. Sh. 1 0 l0yt3/2 sil 2msbk mfr as 2f 6 8 2 6 10 /3 sil Irnblk mfT cr if .6 3 14 - 31 1OyW4 Sid 2mabk mfr ew If .4 .6 4 31-40 10yT4 /4 Ct5yr5B sic lmsbk mS - - •2 .3 5 40118 7.5yr4/4 vfsl 0M dvh - - .2 .5 7 coring ri Boring 101.31 18 -31 " Pit Ground surface eiev. ft. Depth to limiting factor In. W Application Rabe Horizon Depth DominentColor Redox Deawiption Teodure Structure Consistence Boundary Roots GFOM In. Munsell Qu. Sr- Cont. Color Gr, oz. Sh. 0EM2 1 0 -5 10yrM - sil 2mcbk mfr as 2f .6 .8 z 5- 13 1 513 sil I m1�1 mfi cw If 4 .6 3 13 -18 IOyr4 /4 sicl 2msbk m* ow if . 4 18 -31 10yr4 /4 ntsyrsn sicl lmsbk mfr ow z .3 5 3140 7.5yr4/4 vfs] Om dvh - - .2 .5 Effluent #1 I30D a 30 22D mg1L and TS$ X30 < 150 mgt = BO rrrgrl- and TSS g 30 mgn CST Name (Please Print) 8lanatur �.— –b CST Number Tho .Nelson 227387 Date Address uauon Conducted Telepnone Number 1432 120th Street, New Richmond, WI 11/17/04 715 -246 -2454 U9 55 AM 4t Cno n County Plan /Zoning 1 386 -4686 2/3 Property Owner AHM Properties T..LC Paroel ID 0 Pendi Page 2 of 3 E Boring # ■ $O t 100.51 17 -32 Ground surface elev, ft. Depth to limiting factor � In. Soi! pliodort Rate Horizon Depth Dominant COW ReCW Deacrlption Texture Structure Consistence Boundary Roots t3PDM In. Munsell Qu. Sz- Cont 001ar Car. Sz. Sh. '� 102 1 0-4 10yr3/2 - sil 2msbk me es 2f .6 .8 2 4-17 5 - Ell Im 1 mfr ow if 4 .6 3 17 -32 10yr4/4 12f5yr5/8 sic] lmsbk mfl' Cw - 3 4 32-44 7.5yr4/4 - vfsl Om dvb Cw - 12 .5 5 44-50 7.5yr4/6 - Is 085 ml - - .7 1.6 E Boring # Boring ph Ground surface elev. R, Depth to tlmtting factor In. goil — Appliosoon Rate Horizon Depth Dominant Color Redox Deseptlon Texture Structure Consistenoe Boundary Roots GPD1fr in, Muneell Qu. Sz. Cunt Cofor Gr. Sz. Sh. 'E?W *Ef1:4t2 Boring # Boring EE JJ Spit Ground sur(aos elev. }t Depth to limiting factor In Sofl Avdication Rabe Horizon Depth Dominant color Redox Description Texture St Uoture Conataeenoe Boundary Roots in. Munsell Qu. Sa Cont Color Gr. f3z. Sh. 'Eff#1 - EfW Effluent tM = SOD > 30 t 22C myL and TSS a30 $ 150 mo/L • Effluent *2 = BCD, ` 30 m VL and TSS < 30 rM& The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alt,ern= fbrmat, please contact the department at 608 -266 -3151 or TTY 608. 264 -8777. seass�or� prme� I n Q3 2010 0955 AM St. Croix County Plan /Zoning 715- 386 -4686 3 / 3 Scale ao M , Woodland Meadows � S IM7 Tbp of conduit pipe 100.00' Lot W2 Top of conduit pipe $SAKI 9 81 100 .er BZ 101.31' 13 '100.51' 1 �C 1 to o f 0 t s° b 3 sl h S 9 k� Thames Nelson 227387 07/14/2010 11:27 FA.'I '715 248 7784 A C E SOIL 8: SITE EVAL. 19002 era Qk CetiA .jas07 �." ' -Z 33 3 ld� 9, �/a eF'u /a..d�e4e6a ww-f& , sec /, r. "art,, .P t9 , Vm . aJ•Sowtcrsist $& " C u � pa/. �'o3.z- st6d -�+ f'�OA:'tu� ystorsgdat s'.2. 16 ,Y�'t�•3:8 - 3'S''�' 6 �ri , � , on , 1 Iry �7tLta tCY Qt� �� X �7..�8 - 6�1' Jot ptap Pryavaed w�.11 y(r' —� /rcot�oh 3 '1 can d� 3 bedroew. e lk ''a�p;'r�nfG5L1- ^X CON (rR3 l�C. ® any�b1�.4�A'A vreoRlvr£R/E.or: C. low : 1 p a' (�:,d �c.f�t.�;, cal ��D - ---•� 1 ` ,t�r� / 0,/ Wisconsin Department of IL EVALUATION REPORT Page I of 3 Division of Safety and Bui ings in accorda, with Cod i r County StCroix Attach complete sit n n paPer notles9 than 81 x 11 inches in size. Plan must of i ertical and horizontal refe noe qqp���� ((�� �cN��eo�=q� parcel I.D. Pendin rnsions, north arrow, and catioiSFtddisrlL�eto�lestro �. 01/ / —&D Pse print alt hfio At. C K 01 X COUNT Reviewed Date Personal information you provid .mey be used for seconds osa��111AJ�e flv�sl Q�04 (1) ( ). Property Owner Property Location AHRH Properties LLC Govt. Lot NW 114 SE 1/4 S 1 T 3 N R 19 EE ( W Property Owners Mailing Address Lot # Block # Subd. Name or CSM# 404 Screen Avenue 9 - Woodland Meadows City State Zip Code Phone Number ity Village ■ Town Nearest Road New Richmond I WI 1 54017 ( 7j5 222 - 0169 CTH E] New Construction Used Residential / Number of bedrooms 3 to 4 Code derived design flow rate 45 0 t 6 00 GPD 0 Replacement Public or commercial - Describe: Parent material Loess over glacial till Flood Plain elevation if applicable NA ft. General comments and recommendations: Site suitable for a mound system U / ;A- 0 �1Q� " Boring # 11 Boring El Pit Ground surface elev. 100.82 ft. Depth to limiting factor 31 -40 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fl? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EfW 'E1f#2 1 0-6 10yr3 /2 sil 2msbk mfr as 2f .6 .8 2 6-14 l0w513 sil lmblk mfr cw if .6 3 14 -31 10yr4 /4 sic] 2msbk mfr cw if 4 6 4 31 - 40 10yr4 /4 f1f5yr5 /8 sicl lmsbk mfr _ _ • 2 .3 5 40-48 7.5yr4/4 vfsl Om dvh - - .2 .5 F 2 j Boring # Boring 101.31 18 -31 pit Ground surface elev. ft. Depth to limiting factor in. Soil Appl ication 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 1 0 -5 10yr3 /2 sil 2msbk mfr as 2f .6 .8 2 5 -13 l0w513 sil lmpl mfr Cw if 4 .6 3 13 -18 10yr4/4 sicl 2msbk mfr ew if 4 6 4 18 -31 10yr4 /4 f1f5yr5/8 sicl lmsbk Edvfh cw - .2 .3 5 31-40 7.5yr4/4 - vfsl 0111 - - 2 5 ' Effluent #1 = BOD > 30 220 ng/L and TSS >30 150 mg/L ' gPuW #2 = BOD rrg/L and TSS < 30 mg/— CST Name (Please Print) Signature CST Number Thomas C. Nelson 227387 Address Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond, WI 11/17/04 715- 246 -2454 Property Owner AHRH Proper LLC Parcel ID # Pending Page 2 of 3 3 Boring # Boring 10051 17 -32 Q . ft. Pit Ground surface elev. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-4 10yr3 /2 - sil 2msbk mfr as 2f .6 .8 2 1 4 -17 10 5/3 - sil lm 1 mfr cw if .4 .6 3 17-32 1Oyr4/4 f2f5yr5 /8 sic] lmsbk mfr cw _ .2 .3 4 32 - 44 7.5yr4/4 - vfsl 0m dvh cw - .2 .5 5 44 -50 7.5yr4/6 _ is Osg ml - - .7 1.6 F Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil AWication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/1l? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM 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/I_ 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- 8330Teat (R_07 /00) i s Woodland Meadows Scale 1 „ 3Q , SM1 Top of conduit pipe 100.00' Lot 9 BM2 Top of conduit pipe 99.65' 01100.82' 02101.31' 83100.61' N C 116, 1 de n � o s o - 6 �l ti l � b 3� �S DR' S � Thomas Nelson -z 227387 �� -- m S f Z 3 Co Lo J Q J (�2 3 � SF � � g 4 O 6J Ln f i j O CD C-4 co Lc , C4 M Cl) i i v ' co CO LCI L O `t LO U t CC'S Q Q {} n �[) ,�, _,_- ..,._�,.�lwR... _ CSI (�C pp I V C3 ST IC3 r cq z LO E2 ca `! ..,.. yam+ ._ �..,. ........�..._._._..,.,�_,...... �� �...„, ��.•.,.,•.,_....w.,.. , ... RC��m. �.w_._.m��._._,W.S.if..Lt...... ...a.�....�� ,�,.. ._..,._ro.._...� ..,....___ °_.._°_°__� � :.... , �O � c i' � i w CL K � U �/� E l _ WOODLAND MEADOWS (A COUNTY PLAT) Located to the Northwest Quarter of the Southeast Ouorter and the Southwest OUarter of the Southeast Ouarter of Section 1, Township 31 North, Range 19 West, Town of Somerset, St Croix County, Wisconsin. 3s 11/ E CURVE TABLE CURVE RADIUS DELTA ARC CHORD CHORD BEARING ------------ TA NGENT BEARINGS C1 7 LOT 24 33.00' 4 Y 1 4 16.4 N11V2' Ilel LOT 2J 1 D" 54 4 7' " NOYOIIO Lei 1 A � WB• .1O,�N CJ 1 1 7 4• W 'aa Cd 37 . 1 4 1 J6' 1 1' + '46' 2; / / /IIR11� �) SOI'IS'46'V LOT 8 3 1 1'IB" 8 .52' B ♦• SO 9'3 'W 501 15'd6'V 17 YW � LOT 5 18'2T'41" 1' •7' g� �, 19. S �{/' , , V C7 167.00 1 '4 ' 7. 1' 37 N '4110 N1 4' •{ '00' S1. SO641'10'W 791 W 136' 3 4' 'W r9e CB ' N70'1 N81 6' 588'01'5 3'SB'E C9 1 7.00' 1'44' S" 63.35 82.87' 1V6,00.5 "W S70'l3'S6'V NBB 1' 'W WAPNrC N ALE CIO scr1F m FgT: a -lea tilt North I/4 Comsr rrr Section 1-J7 -19 (Fa-d P.N. Nog) UNPLATTED tix UNPLATTED LANDS E f r 4 Garner LANDS 8 S 11 1 -J1 -19 (found 3Lrwy N-) j„' - 598771 S7 E 527J.62'- 130, 77J S88'01'57 "E 1317,12' E 16 =r 1/4 the SB691:S>"E iaBS7 625.55' Lsr. '� 625.55 599 771 5 7 7 N9=f / amJe 9769 1• nr � \JA / ~ m `'S',••8. asa � Seefbn 1 -JI'19 o w E -.aa o' ua7J9 sq. /f. �' — -i (Found Aiothk m JO'U oeroa $ .! T aq R. aanrr dm___ B. o. - loor.o' g s .100 oo C ocr.= 9. a-10026' 0. S88'O1'57 "E 625.55' 625.87' V I r tl y JI I J3' JJ' tJq 900 =q /r. to 2 $ 1JR 7J9 eq. It. I — .100 ocrea $ ao0 a— — ° ,$ '� 1002.7' i z � io g S88'01'57'E • SSBVI'57'E 00d IN 625.55' ' 626.19' 134 739 00.59 n v I X7 I� JDO - — I Jot pro= iZ Im I ly o17.J� e I-f 587'35'19 "E 625.71' S88V7'31'E 1 Y1 I 0 295.20' 330.51' 826.48' N o. I r Z 0726 0111 m U 0 JJd1 sq = ft. m 17 IJ0.96J y ' N 1 >E a aq /r. 1 . rn I30,805 sq. ft. :... _ 016. + q J01 aY LB. 0.1011.0• J00 ocrea : u S88'07'31'E A / u ru a ✓ / : \ 689.39 h!� a 66Gro y. :Y4 �\ u .4 CW- J= -aae u E. ........... ....... . Bear'al.C......... ............. . Y' 4 . l 1Y� 114 Z J a `51,101 aq. /r✓ I I... _ — 1 , N J. +•� i J Pcrw 14 J I D �L.B.O. -7021.5' 017 4 ly � aoxaa i N \ m 'q a .m m?•i^ II. �` Y4 I m al9.a' W .M - 295.12'wo, r eiw;"q• Qej % ✓ � � °1 584V1'S7 "E 539.78' r7 y 4 re].J W l' N83'S2'29 Er 8 \4] J/ �IY \ 1 0 4 °: -N BVI'5Y 537-,8]'- 4 7 J I 1 -U. 1 — 327.78'_ —CTO� \ �• 1J1.024 A ti O J01 a `t a5� L.B.a.1o 24.0' LLQLNp VICMRY MAP Section Corner Monument of Record SEC. 1, T. 31 N., RAS W. NOT ES: TOWN Di SOMERSET, ST. CROl% COUNTY. Y4 0 Sat 1 -1 /4" x I8" Reber NOT TO Vo (Neighing 4.303 lbe. per Ilneor foot) ELEVATIONS ARE BASED ON AN USGS NAVD 1988 DATUM. . AT � Prepared for and at ,,,,,, Building Set CED TO THE NORTH -SO back Lone Ue reWael ol: (100 from Right of Way) BEARINGS ARE REFERENUTH QUARTER LINE OF OYMER: _ — . - pro d Driveway Location SECTION 1, T31N. RISK IS ASSUMED TO BEAR N00'18'10'E . y AM . Properties, LLC p °e N W I I. 404 S. Green Avenue -- -- 12 Utility E.—t 7HE PARCELS SHOWN ON THIS MAP ARE SUBJECT TO STATE. COUNTY N E 11 New Richmond, Al 54017 — _ Dallneoted W.U.nd Boundary AND TOWNSHIP LAWS, RULES AND REGULATIONS (I.e. WETLANDS. 715- 222 -0 - MINIMUM LOT SIZE. ACCESS TO PARCEL, ETC.). BEFORE PURCHASING 114 Wetland Area. OR DEVELOPING ANY PARCEL, CONTACT THE ST. CR01X COUNTY — L.B.O Lowest Building Opening Elevation ZONING OFFICE AND THE APPROPRIATE TOWN BOARD FOR ADVICE. JOB N YA057S640 (2' obove 100 -yeor high water elevation) NO OWNER OR RESIDENT SHALL DO ANYTHING WHICH WOULD Prepared by. Michael H. Lyrskey H.W.E. 10D -Year High Walar Elevation CpMRPREHENSIVE WATER DRAINAGE SOIL EROSION PLAIN A N OR THIS I E W 9 E LNITE gg9.99 Benchmark (Top of Iran Pipe) O CTNO,CALTERINCUTFILUNG ?OR EXCAVATINC PLAN IN WITH ConsNtlJrg Group, IBC. 0 r Phone No. (715) 246 -4319 RUN WAYSN WATER CULVERTSW ER.S 0. OR SEEDNGSATER CWNTY TIIIm% HIGHWAY 'N' Fax No. (715) 246 -3830 P.O ALL OTHER LOT CORNERS ARE MARXED . Boz 325 New Richmond, WI 54017 (WEIGHING 1.13 S 113 BS. ER LINEAR FOOT). 18" O.D. IRON PIPE SHEET 2 OF 3 SHEETS L ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer S n Mailing Address z /- Property Address d 3 3 3 4P (Verification required from Planning & Zoning Department for new construction.) City /State ��� (a\ yL 6Yl (j Parcel Identification Number o� 2 9 1 LEGAL DESCRIPTION Property Location Yv '/4 , '/a , Sec. — I — , T — 3LN R 1 W, Town of S�mer Subdivision Plat: W o d Cwd Lot # 1 Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house yes ' no Lot lines identifiable '__! yes no 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 plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and /or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 1 /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 arn/are 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 PLICANT(S) 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) . � 1 111111 11111 HIII Illll 11111 ilili 1114111111 Illl Illl STATE BAR OF WISCONSIN FORM 2- 2000 * 9 1 1 2 8 0 1 Document Number WARRANTY DEED 9 BETH PABST This Deed, made between The Burnside Registered Limited REGISTER OF DEEDS Liability Partnership, a Wisconsin Limited Liability Partnership, ST. CROIX CO., WI RECEIVED FOR RECORD 02/02/2010 11:05AM Grantor, and Jason D. King WARRANTY DEED EXEMPT r REC FEE: 11.00 TRANS FEE: 60.00 Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum:) Recording Area Lot 9, Woodland Meadows, Town of Somerset, St. Croix County, Name and Return Address Wisconsin. Return to: Premier Title Insurance Agency, Inc. The undersigned, Kenneth M. Duncan, hereby states that he is the 7300 Metro Boulevard #300 authorized general partner to execute this Warranty Deed on behalf of Ed MN 55439 The Burnside Registered Limited Liability Partnership, a Wisconsin A9— " Limited Liability Partnership. 032 - 2181 - 09 - 000 Parcel Identification Number (PIN) This Is not homestead property. 6i5tJ (is not) i Exceptions to warranties: easements, roadways, rights of way and zoning restrictions. Dated this day of January 2010 THE B[JRNSIDE }2EGISTERID LIMITED LIABILI PARZNERSHIP, A WISCONSIN LIMITED * * LIABILIT�YF BY: + + KENNETH M. DUNCAN, GENERAL PARTNER AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. County authenticated this day of �i•' 1� Personally came before me this 2 day of January 2010 the above named Kenneth M. Duncan * TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the persons) who exe the fore (If not, ;. authorized by § 706.06, W is. Stats J ins ent and ackno ged the same THIS INSTRUMENT WAS DRAFTED BY Bruce P. Anderson, ANDERSON LAW OFFICE Notary Public, State of WIS N 1 Balsam Lake, WI 54810 My Commiss is p r anent. (If not, s .tNZp (Signatures may be authenticated or acknowledged. 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 Of 1 FORM No. 2 - 2000 INFO -PRO (800)855 -2021 www.infoproforms.com o Ryan Yarrington From: Stoltz, Carrie R - DNR [Carrie.Stoltz @wisconsin.gov] Sent: Thursday, November 12, 2009 9:33 AM To: Ryan Yarrington Subject: Bill Grubbs Navg deter Hi Ryan, I thought I would send you an email on this one. Owner: William Grubbs Site location: 2350 80th Street, located in the NE /SE quarter in Section 1, T31N, R19E, Town of Somerset, St Croix County. The (2) ponds on Mr. Grubbs property are man -made and are non - navigable. The large wetland complex and man -made pond in the NW /SE quarter in the Woodland Meadows Subdivision, lots 7 & 8 are also non - navigable. If you have any further questions, please feel free to give me a call. Thanks, Carrie * Carrie Stoltz Water Management Specialist Baldwin Service Center West Central Region Wisconsin Department of Natural Resources ( *) phone: (715) 684 -2914 Ext 119 ( *) fax: (715) 684 -5940 ( *) e -mail: Carrie.Stoltz @wisconsin.gov 1