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HomeMy WebLinkAbout038-1215-10-000 PP �cortsin Department of Commerce PRIVATE SEWAGE SYSTEM St. Croix afety and Building Division ` County: INSPECTION REPORT Sanitary Permit No: 506350 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: Elite Design Homes I Star Prairie, Town of 038 - 1215 -10 -000 CST BM Elev: Insp. BM Elev: BM Descripti n: Section/Town /Range /Map No: t Ozj / C.S 11.31.18.1182 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER d CAPACITY STATION BS HI FS ELEV. Septic , I 0 Benchmark /d - O 116 /46 stn Alt. BM Aeration o G�c. Bldg. Sewer sit 5.3"a a Y; (0 Z. Holding St/Ht Inlet ��// �� TANK SET C St/Ht Outlet INFORMATION 7• TAP /62 TANK TO P 7 3 K WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic �T / AJ�- Z1' q� Dt Bottom ` \� Dosing 7 b Header /Man. Aeration Dist. Pipe If Z. e1$ • 3 1 //.7 Holding Bot. System I Z • Z 47 .4 IZ•? r t7 .3 Final Grade S- /� /� PUMP /SIPHON INFORMATION la: G Manufacturer Demand St ve t 1 �� s ?s GPM t•.'I �-c�. cou C '7 , 6 ' 7 Model Nu 76er TDH Lift Friction Loss ISyst ead TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length I / No. Of Trenches PIT DIMF�ISIONS No. Of Pits Inside ia. Liquid Depth DIMENSIONSg� �> >- SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR . I Type Of System: UNIT i 4 v a_L4,, 3 � N Model Number: C b w. DISTRIBUTION SYSTEM Z 1 d'ZZ = `f3 10 Header /Manifold 0 I Distribution x Hole Size x Hole Spacing Vent to Air ntak Pipe(s) \ ` 3f Qv+a Length fo Dia Length ° 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/TrenchCenter A Bed /Trench Edges ` Topsoil dyes ,.';.,f No Yes i No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1247 224th A n e Star Prairie, WI 54026 (NE 1/4 SW 1/4 11 T31 R18W) River Place Lot 21 Parcel No: 11.31.18.1182 1.) Alt BM Description = I ry I 2.) Bldg sewer length = Z(4 - amount of cover �'�-- V Plan revision Required? Yes -) No Use other side for additional information. Date Insepc is Sign ure Cart. No. SBD -6710 (R.3/97) commerce.m.gov Safety and Buildings Division County a 201 W. Washington Ave., P.O. Box 7162 � 55 �t r r I tl is ft n s i n Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in b y Co.) Department of Commerce J Sanitary Perinit Application S tate Transit tionNu r f In accordance with s. Connor. 83.25(2), Wis, Adm. Cade, submissi nn of this form to the :be overnenen on is required prior to obtaining a sanitary permit. Note: Application forms f`tir sowne ?'S are Project Address (if different than mai[big address) submitted to the Department of Commerce. Personal information you provide may used for secon u x)scs in accordaa with the Privac Law s. 15,04 1 m , Stats. i /� t1 ��' / /� 1 Application Informa - Please Print All Infor do ,/i^' / y A- Property Owner's Nance , Parcel p 17,15 16 06C) Property Owner's Mailing Address Property Location Govt. Lot City, State Zip Code Phonc Number �.. ' /.. Section��� T Y/ N: k circlE pnt IL Type of Building (check all that apply) OI Lut � `- { or 2 Family Dwelli Number of Bedrooms to Subdivision Name l %stk " _ Z va � P- r Z11 Block ' � O Public /Commercial - Describe Use ptoaa Q Cry ot`__ Q State Owned - Describe Use CSh Number ❑ Village of +'Z? O Town of lil. Tylre of Permit: (Check of y one box on lice A. Complete litr 8 if applicable) A. ' System (] Replacement System ❑ '1'reatmentlHolding Tank Replacement Only ❑ Other Modification to Existing System (explain) I ts. ❑ Perrnit Renewal ❑ Permit Revision ❑ a of Plumber 0 Permit Transfer to New i Change List Previous Permit Number an'd Date Issued Before Expiration Owner I V. Type of POWTS S YstenrlC omponent/Device: (Check all that apply) t Non•PreSSUI - iZed In-Ground ❑ Pressurized In- Ground ❑ At-Grade ❑ Mound > 24 in. orsuitable soil ❑ Mowxl < 24 in. orsuitable s i1 Holding Tank ❑ Other Dispersal Component (explain)__ ❑ Pretreatment Device (explain), tent Area Information: Design Flow (gpd) Design Application Rate( A Dispersap Area Required (st) / Dispersai Area Proposed (st) S n Soil Vt. Tank Into Capacity in Total N of Manufacturer { Gallons Gallons Units .0 u R o u New Tanks Existing Tanks ^/ ` ^ w , g i 0. t y A Septic or Holding Tank Dos' i+tg Chamber } Vil. Responsibility Statetrtent I, the under assume responsibility for installation of the POWT wit on the attached plans Plumber's Name (Print) Plumber's Signature M PRS Number Business Phone Number Plumber's Address (Street, City, State, Zip ode) --" VIII. Count !De artment Use Onl ypproved Q Dis roved Permit Fee Date 1 sued tssuirtg tx Signal re ❑ Own en R for D enial Asa ,a I IX. Conditisll asoms for D a ,royal c� " t. tank,effluentfiferan 11 .3, QJ; 1 �,�p�,.p u � ^e dispersal cell must all be services / maintained � / as per management plan provided by plumber. w +� ��^+�- -A-��� a*►�+t. 4 0 2. AD'si1back requiremertts must be maintained Attach to cotnplete plans foc" tie system and suimi td Ute ou only oo paper not less than s x I 1 inches in size SBD -6398 (R. 01/07) Valid thru 01/09 XMI G 'Oey , � /' 5' Y4t / "� e XM Q� R/ o ti Wisconsin Department of Co erce SOIL E LUA 10 T ' . P 1 / of _� Division of Safety and Building �Iid b- ppri�bl �je.w.�y 92 �+�V ancet th Comm 85, Wis. Adm. a Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel 1. D. 613 —�p� �5 —�Q Q� percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. evie y Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). D Property Owner Property Location Govt. Lot NE 1/4 SW 1/4 S 11 T 31 N R 18 X (or) w Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 573 Qty. Rd. "A" 21 na River Place l� City State Zip Code Phone Number ❑ City ❑ Village ❑ Town ad . 81 -5405 Star Prairie 1 Hudson 54016 (715) 3 , ER New Construction Use Residential /Number of bedrooms 4 Code derived design flow rate JJAWW � � �tD ❑ Replacement ❑ Public or commercial - Describe: J � rid Parent material _o ; u twas h Flood Plain elevation if applicable General comments -dog( N G � and recommendations: �) & "I t . 1 .�*'" trenches @ el. 94.70', spaced to code 3.50' below grade 1a` ?.' t �` g Boring # Boring 1 ® pit Ground surface elev. 98.20 ft. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -11 10 4/3 none sil 2msbk mfr cs 2f .5 .8 2 11 -32 10yr4/4 none sib 2msbk mfr gw if .5 .8 3 2 -120 7.5yr4/4 none LC r cos osg ml na na .7 1.2 � 2 r Boring # Boring F 2 1 ® pit Ground surface elev. 98 ft. Depth to limiting factor 120 in. = GPD/ff Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roo in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0 -7 10yr4/3 none sil 2msbk mfr cs 2f .5 .8 none 9W 3 30-120 7 5 4 4 rion Effluent #1 = BOD > 30 220 mg/L and T >30 < 150 mg /L ent #2 = BOD : 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature • CST Number Gar L. Steel 02298 Address �atelion Con uded Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 6 -27 -2001 715- 246 -6200 Property Owner I aCaSSe DeVel op!M n t , InC . Parcel ID # Mndi ng Page 2__ of 3_ Boring Boring g # Pit Ground surface elev. 95.80 ft. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 -10 10 4 3 none sil 2msbk mfr Cs 2f .5 .8 _ it 2msbk mfr 1f .5 .8 3 30-19 7-Syr4/4 none (Fr cos Osq ml na na .7 1 1.2 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 GPD1fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring ❑ Boring # Ground surface elev. ft. Depth to limiting factor in. El Pit Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlfF 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.6 100) f Property Owner LaCaSSe Devel =talen , InC. Parcel ID # pendi ng Page 2 -of 3 Boring ❑ Boring g ❑ Pit Ground surface elev. 95 ' 80 ft. Depth to limiting factor 20 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 1 -10 10 4 3 none sil 2msbk mfr Cs 2f .5 .8 it 2msbk mfr qw 1f 1 .5 .8 n e Mr Cos os ml na na .7 1.2 a Boring # ❑ Boring — ❑ Pit Ground surface elev. _ ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F] ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 EFE T 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.6/00) r STEEL'S SOIL SERVICE Gary L. Steel 1.554 200th Ave. S11 T CSTM2298 LaCasse D Inc. 31 - New Richmond, WI 54017 MPRSW - 3254 (715) 246 -6200 town of Star Prairie lot #21 -River Place this soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test conducted. N 1 11 =40' BM.= -top of 1" pvc pipe @ el. 100.00' alt. BM.= top of 1" pvc pipe @ el. 96.80' X03- a . 5 b a� Gary L. Steel 6 -27 -2001 LLD MALL ROAD - • --__._ — /89 °51'46 "E 2205.81' c� 3 42.20'— -A -1 6 6' [80.14 147.78- I Z I 38 9 ° 45'29 "E 441.88' O u H.1 .OT 16 I LOT 1 a 2.556 AC Poi 166 ACRES 1. L ACRES 111,338 SO FT ,356 SQ FT I I W I 77,944 So FT I m a I� L .89 353' — — O _ — 270.33' 352:22' — Os _ 889 °54'86 'W 628.18' —50 01 �— — �a --- PUBLIC ROAD O T 15 I o a? N ° a4'a6 "E 628.18' 18 9 ACRES 8 230 Q FT V C — —326.33--.— -- — — — — A I a I O H.W.L. = 9 6.50 -- 1 3oy.8a' — _ �, W • LOT 21 H.W.L. = 938.5G i .+ 2 , B``N 2.500 ACRES .1 08,879 SO FT 347.39 C 1 LOT PONDI 8° g6'3� 30 DRgINAC1E N NG AREA $�, � �� 45 "VV 42.19, EASEMENT w W AREA TO ME 4 3.434 A --------------- � - --�� �� i' s'b2o� m w 149,596 ' 14 Vy �� !\ w a AREA To c / ,, 1 •�� N8 0 6;, N 4.a ACR ACRES , SO FT 1 Or 131 - b . • / % �C�� o / 183.10' 282.99, �FVk too S89 °5146 "W 436.09' / X15. do_f14�, c2 C7 r ' �/ p 0�� / /� g3• gZ u z LOT 22 gy m, _. •..,, . r .... • • f j // 3Ni1 a3QNM3W O / I, + s3a�V o•z I J , ee W �ps Z ,� / ''M'H'O Ol V3aV 1W bS 0SV LL I I 4 / S3aOV se9' L eo eo II 3N1'1 WHONV3W Ol V3aV I I 10 / � W M i `♦ I , �� O$ zVo I roC I �� Sep 05 07 08:13p Brendon M.. Stryhn 715 - 246.44245 p.1 vcy w w v+.cr}r u �v�eiv rvavLL f I*i 9 F* -L444 p.1 ST CROIX Coulwy SEPTIC TANK MAINTENANCE AGREEMENT AND fir- / � a! tfi OWNERSHIP C;sRTIFICATION FORM OwnexBuyer C. 1,^� -e Ui fi et t 5 Mailing .aaei d y 9 f,� vt /U. mac.,, A; 1, ftaper A&W= 112 q A2q 1 -- ,yvt . ( kl�rr 4 N fww tar new conmtwd=) City/State S' ky" P4-4 r 1C �✓� Parcet Mentification Number 3 j I d ' - -1 t7 —o v O LEGAL DESCR� / �` / Property Location .dam_ _�.� r /�, Sco ` . N-ML�Fw, Tov of �.V s rLt 6r c Subdivisi.. A., Ce IAt # , . Casrliried fey Map # volume - Page # Warranter Decd # volume page # _ Spec house 0 Yes � no Lot Bass idetifiable 6 Yes 0 no _SjMM@d A A�� ' b 4pttope4 11 eaM =ooddwankio9sp fiM ohamftw4ww&PxQparma=oaMaoe consi is of pamrpierg art dw septic toot eoeey Wave l"rars or souses, if n*m%dby s liv== dposoopec What 7oa pot iab &e system +4st affect lice timt+lio�n of +Ara septic laude ss a tr+eatrneeat stage ioo fbe wasoa dispoad syssem. _ The Wirer, 1 r, ' m well * era SIL Ctoft Im ft Dq ruam a Wm ati eaon form. sipad bj tite owm and by a P�3Y�Far, srsniooedple>ooaberarsedpuo�pa ffi>ei(u tls esam- arstr +lattawl is is ixopero+aaer6tian aod/or(l) aeesia6oaaadpoags� (d'aeoassrreyj,tllre ae taaft is lestctlartt R!3 to of 1 to e. Vw% &a madwtWod hares real ttw rlbom =qwbmma and ayaea to a wdMi s the pa waft awwW Sspmdd sy:ftmvnft *a swn6o ds Oftfixfthwdo , asset by III¢ Dopaaraww cdCraaalmeaaeaad dee D of Nw=d Rre wzxs, aft of Wiaaoeasio. Cmditxtioo 1lnrt"w O&*= heel bears smkkft red seats[ W eospie0ed sa tuftowa ter at tk. Cto L Omay Zemin Off oemidua 30 deys of ills tlste:es yeaur �. S03NATL" OF APPLICAW DATE QW4 CBIIW UM I (we) cadWY *4 AD aftkaleaft as this form airs terse m dw best of my (car) loaewiedga- I (we) acre (arse) des ownegs) of tine Froperty did a viruw of a wa dead tenor& d a Regiaer er Deeds Oltia. (res.l ! S! a 7 sIGNATORE OF APPLICANT DATE «..«s. �� i�assaaaioa dsst :s ,ns- n*mteatod emt► wwk is the smrtay p=wk beiaS revoked by the Zoafog Dcp u t meet- 1110 * " tareteede wills thb app a sftuq eed wwmaty dead isms ft Re&iw of Dec& ott - a copy of des: oesrifiod swmy map if rck nwc is awde in dee wanaaty deed 'POWTS OWNER'S MANUAL & MANAGEMENT PLAN raga _., of FILE INFORMATION SYStf M SPECIFICATIONS Owner 1 J Septic tank Capacity Jr © al ❑ NA Permit At $eptip Tank Manufacturer � i tr..S�Ft< DNA DESIGN PARAMETERS Effluent Filter Manufacturer p V 0 NA Number of Bedrooms p N A Effl Filter Mod el A 11�D __.. Cl NA Number of Public Facil Units }— Q NA Pump Tank Cap g p iJ � a 0 NA Estimated flow (average) p d aUdA Pump Tank Manufacturer �� S� ❑ NA Design flow (peak}, (Estimated x 1.5) al/d I ay Purnp Manufacturer (: 0 L , 0 %,.. 0 NA Soil Application Rate ollda ,/ft? Purnp Model �^ 0 NA Standard Influent /Effluent 0uallty Monthly avera(�d" Pretreatment Unit _ NA Fats, Oil & Grease IFOG) 530 mg /L Q SandllGravel Filter O Peat Filter Biochemical Oxygen Demand (BOD . <_220 mg /L C! NA L1 Moohanical Aeration 0 Wetland _ Total Suspended Soli iTSS) 5150 mg /L Q Disinfe to Other: Pretreated Effluent Quality Monthly average (Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (800 „) 530 mg /L Q lh- Ground (gravity) O in- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L Q NA 0 At - Grade 0 Mound Fo cal Co liform (geom etric mean) 510” cfu!100ml C1 Drip-. 0 Othor. Maximum Effluent Particle S ize 4 in dia. � 0 NA Other D NA -Othe`r_.__ C Q NA O NA ``Jalues typical for domestic wastewater and septic tank effluent. Other: C NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: months} (Maximum 3 sera► ❑ NA Pump out contents of tank(s) When co.m4lno sl aggs and scum equals one -third (Y of tank volume 0 NA Inspect dispersal ceii(s) At least once every; 0 month(s) X year(si ( Maximum 3 years) DNA Clean effluent filter At least once every: El monthls) G7 NA � • r ! _ At yearial Insp pump, pump controls & alarm s At least once every; r-- Ej y e ar s }( °} © NA 0 months) Flush laterals and pressure test ' At least once every; ^---- 0 year(s) p NA Other: - At least once e very , Q months) ❑ NA Other: �..� . " - _ ___ » .. _ .. , Q years) El NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal calls shall be made by an Individual carrying one of the following licences or certifications: Master Plumber; Master Plumber Restricted Sewer; P0WTS in;P9ctor; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(a) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum end to check for any back up or ponding of effluent on the ground surface. The dispersal cellis) 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 51 2 months, shall be gerfprmed 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. of 'START UP AND f]PERATIQ i'ege N -- Pot new construction, prior to use of the POWTS check treatment tankial for the presence of painting products or other chemicals that may impede the treatment process and /or damgpe th0 t. sporsal cl li fe). If high concentrations are detected have the contents of the tank($) removed by a Septage servicing operator prior tg use. System start up shall not occur When soil conditions art' frcl ;an at the infiltr»tive surface. During power outages purnp tanks may fill above normal h)phvyitter levels When power is restored the excess wastewater will be discharged to the dispersal call(*) in one large dose, oVsk6 trJ)ng the Collis) and may result in the backup or surface discharge of effluent. To avoid this situation ha ve the contents of }1e p�M tank removed by a Septage Servicing Operator prior to restoring Power to the effluent pump or contact a Plumber or POWT 'Maintalner to assist in manually operating the pump controls to restore normal levels within the pump tank. Go not drive or park vehicles over tanks and dispatsa) cells. Pq not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at- grads soil absorption 'sren. Reduction or elimination of the following from the WaeteWstst stresto ma improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; apndpmsl cpitton swill0 , degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable 0001ings; gosplinoi grease; herbicides; meet scraps; medications; oil; 1. painting products: pesticides; sanitary napkins; tampons; and w4tor softenel brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of serllios the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Caritr» 83.3, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected find the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed And pr porly disposed of by a Septage Servicing Operator. a After pumping all tanks and pits shall be excavated Artd removed 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: ❑ A suitable replacement area has beeli evaluated and may be utllizeq for the location of a replacement soil absorption system. The replacement area should be pro;"Jo i from disturban and compaction and should not be infringed upon by required setbacks from existing and proposed structure lot lirlea finial wells. Failure to protect the replacement area will result In the need for a new soli and site evaluation to eetap)IWh a suitable replacement area. Replacement systems must comply with the rules in affect at that time. ❑ A suitable replacement area is not available due to setback andipr soil limitations. Barring advances in POWTS technology a holding tank may be installed a &loaf rseprt t reiplaca the failed POWTS. The site ais not an evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation b+s performed to locate a sultabI6 rep(aCalion_ t arias. If no replacement area is available a holding tank may b tadte s a last resort to replace the failed POWTS. Mound and at -grade soil absorption systems may 0* reo I oniptructisd in place following removal of the blomat at the infiltrative surface. Reconstructions of such systems rtitiat aornply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL MASSES AND /OR INSUFFICIENT OXYGEN, DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK L►illOP :A I- IRCE IOSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY era b1priGttl.T oR I p ilaLt. ADDITIONAL COMME POWTS INSTALLER ,, _ p ` 8 � NTAiNER ­ Name — �if''.� t Alarn. Phone °7 / t' ... 3 8 - -,3 1 phone SEPTAGE SERVICING OPERATOR (PUMPER) I•CfCAL REGULATORY AUTHORITY Na me Item Phone Pltener 7(S rrus document was dratted in compliance with chapter Comm 83.22(x)Ip)itltdilktfl end;3 .54(t), (2) & (3), Wisconsin Attrninistrauve Coax. r - SEPTIC TANK E PUMP CHAMAER C RA S S SE C'�T GN A. :�rL7 Sr�ECxF'iCF.TI�JN 4" CI VENT PIPE 12" MIN. ABOVE GRADE 6 WEATHERPROOF ?:26' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER W/ PADLOCK FINISHED GRADE 4" CI RISER WARNING LABEL 4" MTN. 6" MAX. �+�, 1 ♦ 1 1 r ► i NLE�T 6 1 Ff WATER TIGHT SEALS GAS f ` TIGHT i i► VAPPROVED S JOINTS WITH y�'PROVED -�- ; ALM APPROVED PIPE 'IPE 3' 8 ► ON 3' ONTO )NTO SOLID ' , SOLID SOIL iOIL PUMP OFF ELEV. FT. --c ► t ( OFF ' RISER EXIT D PERMITTED ONLY IF TANK MANUFACTURER 3" APPROVED BE�tDINCv UNDER TANK HAS APPROVAL CONCRETE PAD SPI;C.IFICA:"IONS SEPTIC / DOSS; , / TANK MANUFACTURER: Lf. �.R� NUMBER DOSES PER DAY: `'�F TANK SIZES: SEPTIC GAL. DOSE VOLUME INCLUDING DOSE �` � CAL,. FL:OWBACK: 15 9 GAL. ALARM MANUFACTURER: L*jjcLcxjLM CAPACITIES: A = INCHES = LI�a�, GAL. MODEL NUMBER: ,D t SWITCH TYPE: t'rr�g� B 2 INCHES = GAL PUMP MANUFACTURER: C 0 INCHES AL. MODEL NUMBER: SWITCH TYPE: roes C D = INCHES s 1 Wo GAL. REQUIRED DISCHARGE RATE y O i GPM PUMP & ALARM WIRING AS PER ILHR 14.23 WAC VERT;.CAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . ]a- FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . , . . ,1 FEET + FEET FORCEMAIN X �0 FT/ 10'0 F T. F'RICTI'ON r ACTOR . �' � Tt�TAL DYNAMIC HEAD - FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH .,,..- ; WIDTH DIAMETER ---` LIQUID DTPTH ` e / 6 Pet J� SIGNED! LICENSE NUMBER: Q, DATE: 1/88 MGOULDS PUMPS Submersible Effluent Pump 3871 EPO4 EP05 APPLICATIONS • Fully submerged in high a EPOS impeller: Thermopiles- • Bearings: Upper and lower Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing lubrication and efficient improved performance. construction. following uses: heat transfer, i Casing and Base: Rugged • Effluent systems • Homes thermoplastic design provides AGENCY LISTING Available for automatic and • Farms martial raperation. Auto- superior str ength and corrosion 4F tam Umderdr Amdetbn • Heavy duty sump matic models htdade resistance. • Water transier Mechmical RW Switch ■ Motor Housing: Cast gran (CSA listed model numbers end • l ewatering assdnbted and preset at the for efficient treat transfer, In T or "Co.) strength, and durdblI ty. SPECIFICATIONS M Motor Cover: Thermoplastic Genids how Is as 9001 Registered. FEATURES cover with integral horde and • Solidi handling capability: float switch attachment points. '/4" maximum. • EPO4 impeller. Thennoplas- III 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 (41M continuous Wytks MET 140°F (60 intermittent. • Fasteners: 300 series 10 stainless steel. s 30 _ .._ .. ,-s. .. —sc,PM L .... . . • Capable of running dry without damage to a 2SFr .,, components, c Motor: • EPO4 Single phase: 0.4 HP, g Zo` 115 or 230 V. 60 Hz, 1550 RPM, built in overload with 5 automatic. reset 4 5P05 • EP05 Single phase: 0.5 HP, 60 115 V, Hz. 1550 RPM, '' 3 1 �, ...:...... _, .w......... , .. .. �,.. - .. _ _ .... _. �., _._ built in overload with EPO4 ._ automatic reset. 2 • power cord; 10 foot s .� standard length, 16/3 1 SJTOW with three prong grounding plug. Optional 20 0 00 10 20 30 40 50 GPM foot length, 16/3 SJTW with three prong grounding plug ° (standard on EP05). 4 e 10 12 r�+'!h uaacl>ry Gould Pumps 0 2 000 Goulds Pumps <& ITT Industries Effective Pebruagr, 2000 83871 ��� ' 4003��t�r�FC1 F` E'dE�tdpCF"k3+E5;V1Ft;�IFAA�l7F �''3?.'f''R' �� �4+ FClxT` �5S+ 1UR *0f3�S�i4: At,�',�!�: RV R`,�PLA l OF C 3II.PS 1110 .3tf #1 Gi �� 5t 1#t#�E S7 CfiQ� ` t d t w JA t t t tm ^� 1 d i � � OtDt�.i.��Ytf� � '` ✓fs��z��f °.wrar�vlx,eeGq�ll �,. Newa��ef�cf• i 11 IMP ; �gMlal Wf4tfQl,1 TAN Rte., J { fWMN it i IndChplta# t 1�9wM�ll( ift-w p- LOT l9 f ar4wFx.wa N� LOT t6 Pa�wawau w�msoefl�e Pi DATE X 114 80 FT �* V PU 1C'RO�D ° antPA Ina t o c, G� 1u t sF. � rarer�ee�,r � .. u a et i ' �� n000ie�lor�nat Cu' j LO 21 'w fa -- { 1 I R � y r a iQf; i I total •1 u. A / f , t 'v 1 + � p 1k R r � - ' � v a� . � u ° �. r 1 �'��� • 7o e^. �Egm" (�FammF3JR4$--Yh!+4P p Y t 11 KOOPM N V PA F e " IAk d t Alk70 um Im Tc r , F — d — - ��'���;�.. ptpM9g�ty '�f�tgaiHet�ne+naharn�t� � ,�'�mrcr KA WOO PM lar a upnx i�� ��t�d,�.terlt�lwatN�"o�aanwdrr. too o NO Sao we' TIA RM' 11111! 11111111!1 illil Ill!! hill Ills 1111111111 1111 * 8 5 6 5 4 0 1 State Bar of Wisconsin Form 1 -2003 856540 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS Document Number Document Name ST CROIX CO., WI RECEIVED FOR RECORD 07/30/2007 11:10AM THIS DEED, made between LaCasse Development, Inc., a Wisconsin Corporation WARRANTY DEED EXEMPT I ("Grantor," whether one or more), REC FEE: 11.00 and Elite Design Homes LLC TRANS FEE: 135.00 PAGES: 1 ( "Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is Name and Return Address needed, please attach addendum): River valley Abstract & Title, Inc. 1200 Hosford Street, Suite 201 Hudson, WI 54016 Lot 21, Plat of River Place in the Town of Star Prairie, St. Croix County, Wisconsin File a 2695352 038 - 1215 -10 -000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Easements, restrictions and rights -of -way of record, if any. Dated July 27 2007 LaCasse Development, Inc. (SEAL) (SEAL) (SEAL )`- �+�" -b.°��.ra,c.s�� (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) r ran, , r _ U STATE OF WISCONSIN ) "IQ ar ) ss. authenticated on r Y pllhl� __ . St. Croix COUNTY ) W jSCOnSjn * Personally came be re me on Jul 27 2007 TITLE: MEMBER STATE BAR OF WISCONSIN the above -named K) W CA �S �___ (If not, to me known to be t e rson(s) who executed the foregoing authorized by Wis. Stat. § 706.06) in ru d d t same. THIS INSTRUMENT DRAFTED BY: Attorney Doug Berg N Pu c, State of Wisconsin 1200 Hosford Street, Suite 201 Hudson, WI 54016 My ommission (is permanent) (expires: f (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD HE CLEARLY IDENTIFIED. WARRANTY DEED C 2003 STATE BAR OF WISCONSIN FORM NO. 1 -2003 * Type name below signatures. 1 Oil l