HomeMy WebLinkAbout038-1237-09-000 0 a o\■ 2 0 c
� ( /) \ \ { J / �
7 �
. /
z f 7 z ° S = 8 �•
) / e 0 \ e -
$ 3 \ \ 3 § ƒ \ § 0
\ { / M. G }
L0 N) 0
C 2
C G E
; / / y E > # r
CL
\ / 3 \
\h\
\ z G z
\ ® § $ \ n r
o D o > e o
CD
0 0 3 \ \ �'
p f f * \ « \
/ ƒ Ch Ch CA —: 2
_ o R I E
\ � � /
\ �
\ \
z z \
] 2 c \
(/
En
CD —
CD ` \
2 % \
\ ® a \ w m
7 / / [ \ ® F R
0 \ i z E
\
z a /
/ co CD
m e
CD { \ i
o e ; z
/
z § CO
% o \ w
� !
n >
: 0 «
-
»
{ t
\
/ 0 CL
\ / \
� y
. � f �
. �
� \
� \
' \ %
0 * \
+ f \
/ , : \
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
,SaFftyand Building Division
INSPECTION REPORT sanitary Permit No:
515118 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:
Rudek, Mark I Star Prairie, Town of 038 - 1237 -09 -000
CST BM Elev: Insp. BM Elev: BM Description: , Section/Town /Range /Map No:
16.31.1'&1260
TANK INFORMATION ELEVATION DATA t5,
TYPE MANUFACTURER/ ti CAPACITY STATION BS /D 1 FS E L
Septic `' Benchmark
,L/ pG l. a
Dosing f ) Alt. B
Al
Aeretivrr �, _ Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic 1
-" Dt Bottom l �J • / (¢ �l . 1
Dosing I Header /Man.
Aeration Dist. Pipe
Holding %` " Bot. System
Final Grade
PUMP /SIPHON INFORMATION Z • o /6 Z. �L
Manufacturer Demand St Coyer r
tiAc =,_t�f j L, I GPM i ". t. �. (• Tb
,
Model Number _, � '�
,. t Cy
TDH Li tom Friction Loss System Head TDH Ft i t, -�
1
Forcemain Length Dia. r / Dist. to Well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width G Length INo.OfTrenc PIT DIAI�ENSIONS No. Of Pits Inside Dia. Liquif( Depth
DIMENSIONS D \\ �_
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Qf„Syystem: / yL f UNIT Model Number:
4+
3G
DISTRIBUTION SYSTEM Afo!'A,
11 Header /Manifold Distribution / 011 I x Hole Size it x Hole Spacing / Veo Air Intake
Z Pipes) 7 / 5 �' ( 1 , 7
L Dia Length Z Dia ' Spacing `
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only 5 f�
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center r' Bed/Trench Edges � Topsoil
� Yes 0 No Yes 0 No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /, 1 G Inspection #2: &/ 4' /1
Location: 2172 Cty Rd CC New Richmond, WI 54017 (NE 1/4 NE 1/4 16 T31N R17W) Maple Ha / ugen Lot 9 � Parcel No: 16.31. 17 1 / .260
1.) Alt BM Description = � �r? yiQ.� t i t L'-Zi � � k2 '� y !✓y/ �G�t , 4
2.) Bldg sewer length = °r a , � k Jy
- amount of cover = 4 i f .
•� r
Plan revision � Yes Required? �- „ -_ f. ` % - — �I -
9 � No L E I -_� r t 1_ � jj /
Use other side for additional information. _'f _
SBD -6710 (R.3/97) Date Insepctor's Sigfiature �' Cert. No.
r
ID
commercemi.gCM11 Safety and Buildings Division County
ashington Ave., P.O. Box 7162
SCO n S I n Madison, WI 53707 -7162 Sanitary Perms u ber to be filled in by Co.)
Department of Commerce 5 5 //5
Sanitary Permit Applicat State Transaction Number
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental
unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Adaress different than mailing address)
submitted to the Department of Commerce. Personal information you provide may be used for secondary
p urpos es in accordance with the Privacy Law, s. 15.04 1 m Stats. / ��w C
I. Application Information - a P ' 1 formation / q,
Property Owner's Na Parcel #
AUG 11 2009
roperty Owner's Mailing Address Property Locat o
in
$1 CROZONING OY
PLANNING & ZONING OFFICE Gov Lot ( J
City, State Zip Code Phone Number A!6 y, y, Section
��- (circle one
T REo
II Type of Building (check all that apply) Lot # N;
1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name )
A� SV4 w..: {}eco Block# r!t/
El Public /Commercial - Describe Use
❑ City of
State Owned - Describe Use CSM Number ❑ Village of
❑ .
O X 75 d J $ Town of
I11. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A New System y El Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain)
B. ❑Permit Renewal 11 Permit Revision ❑Change of Plumber ❑Permit Transfer to New
List Previous Permit Number and Date Issued
Before Expiration Owner
IV. Type of POWTS System/Component/Device: Check all that appl
❑ Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil KMound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dispersal/Treat ent Area Information:
Design Flow (gpd) Design Soil Ap lication Rat gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed System Elevation
/500 7
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units y o n
New Tanks Existing Tanks
� � o Y E r
,�
Septic or Holding Tank
Dosing Chamber
VII. Responsibility Statement I , the undersigned, assume respo lily for instaliption of the POWTS shown on the attached plans.
Plumb is ame Wrintl Plumber' i . MP/MPRS Number Business Phone Number )
IS
I ber's Address treet, sty, tate, Zip e)
i
VIII. Coun /De artment Use Onl
Approved dd Permit Fee Date Issued Issuin gent Signatur
teen Reason for Denial $ �p Z • ab V 17 b �
IX. Condi"A #w3MEWeasons for Disapproval r
t: Septic tank effluent fiNer and - 3 t w t A . rC' a
dispersal cell must all be setvfces / maintained % j dC i Si
as per management plan provided by plumber. �° �r
t� ��
2. AN selbackteclwrerYtents mtlet be maintained C� 16 We
4$ Per walic" code / or• s. IP
Attach to complete plans for the system and submit to the County only on paper not less an 81/2 x 11 inches in size
E �� , t
1
SBD -6398 (R. 02/09) Valid thru 02/11
l
d
\j•,"`.� � \ to ` ` y
l l
ff( r !
k
}
EC COPY
o
J
t'1
Y
i
r �
1
1 E
n �^
4
i
+
. r Zvi
i
f
i
I
i
r --
Safety and Buildings
10541 N RANCH ROAD
commerce .Wl.gov HAYWARD WI 54843
Contact Through Relay
i s c o n s i n
w ww.ce.wi.gov/sb/ sin.gov
www.wisconsin.gov
Department of Commerce
Jim Doyle, Governor
Richard J. Leinenkugel, Secretary
August 07, 2009
CUST ID No. 224263 ATTIC• POWTS Inspector
KIM A O CONNELL ZONING OFFICE
K.O. CONSTRUCTION ST CROIX COUNTY SPIA
504 3RD AVE 1101 CARMICHAEL RD
OSCEOLA WI 54020 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 08/07/2011 Identification Numbers
Transaction ID No. 1691577
SITE: Site ID No. 750133
Mark Rudek Please refer to both identification numbers,
2172 CTH CC above, in all correspondence with the agency.
Town of Star Prairie do
St Croix County
NE 1/4, NE 1/4, S16, T3 IN, RNW
FOR:
Description: Mound, 4 bedroom residence
Object Type: POWTS Component Manual Regulated Object ID No.: 1235294
Maintenance required; 600 GPD Flow rate; 20 in Soil minimum depth to limiting factor from original grade;
System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 101), SSWMP Pub. 9.6; Effluent Filter
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be P.o.w
constructed and located in accordance with the enclosed approved plans and with any component manual(s) C011 :. t1
referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance
with all code requirements.
No erson may engage in or work at plumbing in the state unless licensed to do sob the Dep artment per s.145.06, PAP '' l vT
p Y P g� Y P P N of
stats.
The following conditions shall be met during construction or installation and prior to occupancy or use: --'
SEE C'61 ti3f
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
P g p
used to 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.
• Surface water drainage shall be diverted away from the system area per Mound Component Manual.
KIM A O CONNELL Page 2 8/7/2009
• Materials shall conform to the requirements of COMM 84.
• Maintain well and waterline set backs per COMM 83.43(8)(1). 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.
Beginning October l 2008, small wastewater holding tanks with estimated flows less than 3,000 gpd that are
based completely on approved POWTS component manuals must be submitted to the appropriate governmental unit
and will no longer be accepted by the Safety and Buildings Division for review. Please refer to s. Comm 83.22,
Wis. Adm. Code for further information.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the
installation, operation or m ' nance of the POWTS.
Sincerely, Fee Required $ 250.00
Fee Received $ 250.00
Balance Due $ 0.00
Patricia S andorf
POWTS Plan Reviewer, , I at Services WiSMART code: 7633
(715) 634 -7810, Fax: (715) 634-5150, M -f 7:45 am - 4:30 pm
pat.shandorf@wisconsin.gov
Specialist, 715 726 -2544 Friday, cc: Leroy G Jansky, POWTS Wastewater Sp , ( ) , 7:00 A.M. To 3:30 P.M. Y
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,
ma(erial 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.comnierce.wi.gov/SB/SB-BuildingContractorPrograin.htrnl
KIM A 0 CONNELL Page 2 8/7/2009
• Materials shall conform to the requirements of COMM 84.
• Maintain well and waterline setbacks per COMM 83.43(8)(1). 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.
Beginning October 1", 2008, small wastewater holding tanks with estimated flows less than 3,000 gpd that are
based completely on approved POWTS component manuals must be submitted to the appropriate governmental unit
and will no longer be accepted by the Safety and Buildings Division for review. Please refer to s. Comm 83.22,
Wis. Adm. Code for further information.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the
installation, operation or m ' nance of the POWTS.
Sincerely, Fee Required $ 250.00
Fee Received $ 250.00
Balance Due $ 0.00
Patricia andorf
POWTS Plan Reviewer, I ated Services WiSMART code: 7633
(715) 634 -7810, Fax: (715) 634-5150, M -f 7:45 am - 4:30 pm
pat.shandorf @wisconsin.gov
cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 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.comnierce.wi.gov/SB/SB-BuildingContractorProgram.html
I
t
/► /� • •A D ISTRIB UT ION A
MOUN AND PR DI.STRIBU T ION C*tSMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: MARK RUDEK
Owner's Name: MARK RUDEK
Owner's Address: 760 200TH ST
DRESSER WI 54004
Legal Description: NE - -NE S16 - -T31 N - -R17W
Township: STAR PRAIRIE
County: ST CROIX
Subdivision Name: MAPLEHAUGEN
Lot Number: 9 Block Number:
Parcel I.D. Number: 038 - 11237 -09 -000
Plan Transaction No.:
0 nallY
Pagel Index and title (0) Nil
Page 2 Data entry of co au�CE
Page 3 Mound drawings ry
Page 4 Lateral and dose tank
Page 5 System maintenance specifications ti
Page 6 Management and contingency plan
Page 7 Pump curve nd specifications
Designer: KIM A OCONNEVL License Number: 224263
Date: 06/10/09 hone Number: 715 - 755 -3145
Signature:
Designed Pursuant to the
Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and
SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81)
Version 4.01 (R. 09/04) Page 1 of 1
Mound and Pressure Distribution Component Design
Design Worksheet
I
Site Information
(r or c) R Residential or Commercial Design Note: Sand fill (D) calculations assume a
400.00 Estimated Wastewater Flow (gpd) Table 83-443 in -situ soil treatment for fecal
1.50 Peaking Factor (e.g. 1.5 = 150 %) coliform of <= 36 inches.
600.00 Design Flow (gpd)
2.50 Site Slope ( %)
99.70 Contour Line Elevation (ft)
20.00 Depth to Limiting Factor (in)
0.40 In -situ Soil Application Rate (gpd/fe)
Distribution Cell Information
75.001 Dispersal Cell Length Along Contour (ft) 1 8.00 Cell Width (ft)
9.00 Dispersal Cell, Design Loading Rate (
1 Influent Wastewater Quality (1 or 2) Are the laterals the highest oint
in the distribution Y
Pressure Disribution Information network? Enter Y or N
(c or e) El Center or End Manifold
2.67 Lateral Spacing (ft) If N above, enter the elevation ft
3 Number of Laterals of the highest point.
0.125 Orifice Diameter (in) (e.g. 0.25)
3.00 Estimated Orifice Spacing (ft) = 8.00 ft /orifice
2.00 Forcemain Diameter (in)
35.00 Forcemain Length (ft) Does the forcemain drain back? Y_ �
92.00 Pump Tank Elevation (ft) Enter Y or N
6.50 System Head (ft) x 13 5.71 Forcemain Drainback (gal)
8.87 Vertical Lift (ft) 101.08 5x Void Volume (gal)
- 1 0.72 Friction Loss (ft) 106.78 Minimum Dose Volume (gal)
16.08 Total Dynamic Head (ft) 30.89 System Demand (gpm)
.� 1 t
F . Lateral Diameter Selection fi anifuiy Diameter Selection
�) in. dia. options choice in. dia. options choice
0.75 1.25 x
1.00 1.50 x
1.25 x 2.00 x X
Hq x X 3.00
x
3.0 x
Gallons/Inch Calculator (optional)
Treatment Tank Information A 1260.001 Total Tank Capacity (gal)
1260.001 Septic Tank Capacity (gal) 58.00 Total Working Liquid Depth (in)
WEEKS � IManufacturer 21.72 galhn (enter result in cell 649)
Dose Tank Information Effluent Filter Information
800.001 Dose Tank Capacity (gal) JBEST I Filter Manufacturer
21.761 Dose Tank Volume (gal /in) GF 10 Filter Model Number
WEEKS IManufacturer
Project: MARK RUDEK Page 2 of B
Mound Plan View
T
...... ... J
1/10 B ::::::::::::: :::::: ;:;:::;:;:;:;:;:; :;:;:;:. 3 • :
Observation Pipe �...•...
Q ( A
W :
I
B :.... ......
z
3
:. .
L
Mound Component Dimensions
Down slop toe extension made.
A 8.00 ft E 18.40 in H 1.00 ft K Eflft ft
B 75.00 ft F 9.50 in 1 12.00 ft L ft
D 16.00 in G 0.50 ft J 7.33 ft W
600.00 (ft Dispersal Cell Area 1 1500.00 (ft) Basal Area Available
8.00 (gpd /ft) Linear Loading Rate 1 7.50 (ft) 1/10 B Obs. Pipe Placement
Mound Cross Section View
Aggregate Dispersal Area
Finished Grade 102.83 (ft) --
JJ H
�wJIJJJNJNfJ/� { „JJJJfJ w�. G 1 1
.� . f /NfIJJIINNJIfI.a < �.Ii`JIffJIfJIfJf /i..
•
F ............ _ 101.53 (ft) Lateral
Dispersal Cell
101.03 (m Invert
Dispersal Cell -- ..�,...,- ;.;•,::,_ ...... t .
Elevation
E _ __` D s
99.70 (ft) Contour Elevation
2.5 %Site Slope
Geotextile Fabric Cover
Shading Key m I � T Dispersal Cell See lateral details on
10 Topsail Cap
Subsoil Cap c 11.5 ft �t Page 4 for number, size,
f u and spacing of laterals.
JJJffffff � j^"">�)
ASTM C33 Sand o F Laterals are equally
Tilled layer
0.5 ft Typical Lateral spaced from the
J c I
Aggregate `* o —1 ' centertin the
TT �•-- -- A -�� distribution cell (AxB).
Project: MARK RUDEK Page 3 of $
I
End Connection Lateral Layout Diagram
Center the laterals ovor the A & B dimension •- Turn -up vrf ball valve or cleanoutplug
pForcemain P cal If- X � I Hot es drilled on the bottom of the lateral s
equally spaced Laterals & force main of PVC Sch 40 (per COMM Table 84.30 -5)
ction via tee or cross to manifold at any point.
Nu mb of Laterals
Number al 3 Orifice Diameter 0.125 in
Lateral Diameter 1.50 in Orifice Spacing (X) 3.06 ft
Lateral Length (P) 73.44 ft Orifices per Lateral 25
Lateral Spacing (S) 2.67 ft Orifice Density 8.00 ft /orifice
Lateral Flow Rate 10.30 gpm Manifold Length 5.33 ft
System Flow Rate 30.89 gpm Manifold Diameter 2.00 in
Total Dynamic Head 16.08 ft Forcemain Velocity 3.16 ft/sec
Dose Tank Information Locking cover with warning
label and locking device and
sealed watertight
Disconnect
Electrical as per NEC 300 and --►
Comm 16.28 WAC 4 in. min.
t�
Tank component is properly vented E-- Aftemate outlet
location
I
_ Forcemain diameter
WEEKS Manufacturer �_ 2 in.
Ca acit 800.00 Gallons
Volume 1 21.76 gal /inch
A
Weep hole or anti-
Dimension inches Gallons 1 8 siphon device
A 21.86 475.62
S 2.00 43.52 C Pump off e levation (ft)
C 4.91 106.78 92.67
D 8.00 174.08 D
Total
36.761 800.00
Dose tank elevation (ft)
J 3' Bedding under tank. 92.00
Alarm Manuafacturer ISi E LECTRO
Alarm Model Number I HW 101
Pump Manufacturer IWE031 1 L
Pump Model Number IGOULDS J
Pump Must Deliver 30.89 gpm at 7 6 ft TDH
Project: MARK RUDEK Page 4 of $
Mound System Maintenance and O pera tion Specifications
Service Providers Name KIM A OCONNELL Phone ' .5 -7 55 -3145
POWTS Regulator's Name ST CROIX COUNTY ZONING Phone 715- 386 -4680
System Flow and Load Parameters
Design Flow - Peak 600 gpd Maximum Influent Particle Size 118 in
Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L
Septic Tank Capacity 1260 gal Maximum TSS 150 mg/L
Soil Absorption Component Size 600 ft Maximum FOG 30 mg /L
Type of Wastewaterl 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)
P ressure System Laterals should be flushed and pressure tested every years
Mound Inspect for ponding and seepage once every 3 years
Other
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 -``
y. Long Sweep 90 or Two
45 Degree Bends Same
Diameter as Lateral
Project: MARK RUDEK Page 5 of $
Mound System Management Plan
Pursuant to Comm 83.54, Wis. Adm. Code
General
This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component
manuals (SBD- 10691 -P (N.01/01) and SSWMP Publication 9.6 (01/81)1 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 fitter shall be assessed at
least once every 3 years by inspection.
The outlet fitter shall be cleaned as necessary to ensure proper operation. The fitter cartridge should not be removed unless provisions are
made to retain solids in the tank that may slough off the fitter when removed from its enclosure. If the fitter is equipped with an alarm, the filter
shall be serviced if the alarm is activated continuously. Intermittent fitter 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 fitter 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
BOD 30 mg/L TSS, 10 mg/L FOG, and 10 cfu1100 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 leaning 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.
Project: MARK RUDEK Page 6 of
[qGOULDS PUMPS Submersible
Effluent Pump
t
WE Series
PROSURANCE AVAILABLE FOR RESIDENTIAL
APPLICATIONS.
APPLICATIONS ■ Shaft: Corrosion - resistant, Single phase (60 Hz): can be operated continuously
Specifically designed for the stainless steel. Threaded • Capacitor start motors for without damage when fully
following uses: design. Locknut on all models maximum starting torque, submerged.
• Homes to guard against component • Built -in overload with ■ Bearings: Upper and
• Farms damage on accidental reverse automatic reset. lower heavy duty ball bearing
• Trailer courts rotation. • STTOW or STOW severe duty construction.
• Motels ■ Fasteners: 300 series oil and water resistant
• Schools stainless steel, power cords. ■Power Cable: Severe duty
• Hospitals •'/3 —1 HP models have rated, oil and water resistant.
P ■ Capable of running dry Epoxy seal on motor end
• Industry without damage to NEMA three prong g provides secondary moisture
• comp
Effluents stems grounding plugs.
Y components. barrier in case of outer jacket
• 1'/2 HP and larger units have damage and to prevent oil
■ Designed for continuous bare lead cord ends. g p
SPECIFICATIONS operation when fully Three phase (60 Hz): wicking. Standard cord is 20. ,
Pump sub
P Optional lengths are available.
submerged. P 9t • • Class 10 overload protection p
■ O-ring: Solids handling capabilities: 9 P
g p MOTORS must be provided in
maximum. separately ordered starter sealing against contaminants
• Discharge size: 2" NPT. ■ Fully submerged in unit. and oil leakage.
• Capacities: up to 140 GPM, high -grade turbine oil for • STOW power cords all have AGENCY LISTINGS
• Total heads: up to 128 feet lubrication and efficient heat bare lead cord ends.
TDH. transfer. Tested to UL 778 and
• Tem erature: ■ Class B insulation on ■ Design for Continuous CSA 22.2 108 Standards
P o 1 , Operation: Pump atin s are ® By Canadian Standards
104 F (40 C) continuous /3-.1 /2 HP models. p g Association
140 °F (60 °C) intermittent. ■ Class F insulation on 2 HP within the motor manufacturer's C S u5 rile AR38549
• See order numbers on models. recommended working limits, Go„kh Pumps is ISO 9001 Registered.
reverse side for specific HP
voltage, phase and RPM'S METERS FEET 4
available. 130 _
wE15HH SERIES:
124 SIZE:' /: S SOLIDS
35T RPM: 3500 &
FEATURES 110 _ 1750 . _
WE20H —► SGPM
■Impeller: Cast iron, semi- 30 100 sFr
open, non -clog with pump- 90 WE15H ._
out vanes for mechanical W 25 80 E10H
seal protection. Balanced for
smooth operation. Silicon 20 E07H
bronze impeller available as o 6 0 - -
WE05_
an option. 15 so _.
osH
■ Casing: Cast iron volute ° 40 - -
type for maximum efficiency. 10 30 WE03M
2" NPT discharge. 2 " -�`-�-
■ Mechanical Seal: SILICON 5
CARBIDE VS. SILICON 10 ;
CARBIDE sealing faces. 0- 0 0 10 20 3 40 50 60 70 80 90 100 110 120 130 140 150 160 GPM
Stainless steel metal parts, 0 ' S 1 1 20 25 ' 30 1 35 m
BUNA -N elastomers.
CAPACITY
Goulds Pumps
A> ITT Industries
= -•_ -: -- www.goulds.com �/
j gcpggjn SOIL EVALUATION REPORT
#1705
Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of 3
Division of Safety and Buildings Steel's Soil Service, Inc.
Attach complete site plan on pal ches in size. Plan must County St. Croix
include, but not limited to: verti on ce point (BM), direction and
percent slope, scale or dimensio no arrow, and location and distance to nearest road. Parcel LD.
Please py nt alkhmb �rT E D Rev ie By Date
Personal information you provide may used for secondary purposes (Priva Law, s. 15.04 (1) (m)). 7 L 7
Property Owner J 2, 1 20 05 Properly Location T- f
Gronquist, Nels Govt. Lot na NE 4, NE1 /4, S16, T31N, R1)IV
Property Owner's Mailing Address ST, CROIX COUNTY Lot # Block # Subd. Name or CSM# D
416 8Th Ave. NE ZONING OFFICE 9 na Map leHaugen
City State ip a Phone Number City E] Village ® Town Nearest Road
Minneapolis MN 1 55413 1 715 -248 -7278 Star Prairie 1 220Th Ave
New Construction Use: ® Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
❑ Replacement ❑ Public or commercial - Describe na
Parent material Ground and end moraines, pitted glaical drift Flood plain elevation, if applicable na ft,
General comments Mound design, system elevation 101.04ft based on contour line elevation 99. 70ft.
and recommendations: — — T
F-11 Boring # 11 Boring
® Pit Ground surface elev. 99.80 ft. Depth to limiting factor 20 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -10 10yr3/2 none sl 2msbk mfr CS 2f .6 1.0
2 10 -20 10yr4/4 none sl 2msbk mfr gw if .6 1.0
3 20-42 5yr4/4 c1d 7.5yr5/6 sicl 2msbk mfr gw na .4 .6
4 42 -60 5yr4/4 f1f 7.5yr5/6 SI om mfr na na .2 .6
a Boring # ❑ Boring
pit Ground surface elev. 99.80 ft. Depth to limiting factor 20 " in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f?
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -6 10yr3 /1 none SI 2msbk mfr CS 1vf .6 .8
2 6 -20 10yr4/4 none sicl 2msbk mfr cs na .4 .6
3 20-48 5yr4/4 c2d7.5yr5/6 sl om mfi na na .2 .6
* Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD <_30 mg /L and TSS <_30 mg/L
CST Name (Please Print) Si nature: CST Number
David J. Steel 248956
Address Steel's Soil Service, Inc. Date Evaluation Conducted Telephone Number
994 200th St. Baldwin, WI 54002 6/16/2005 715- 760 -0347
SBD -8330 (R.07 /00)
i
1
Property Owner Gronquist, Nels Parcel ID # pending Page 2 of 3
Boring # Boring
Pit Ground surface elev. 99.20 ft. Depth to limiting factor 23 in. Fall Rate
Horizon Depth I Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. '0191 *Eff#2
1 0 -10 10yr3 /1 none sl 2msbk mfr cs 1vf .6 .8
2 10 -23 10yr4 /4 none sl 2msbk mfr gw 1vf .6 1.0
3 23 -60 5yr4/4 c2d7.5 r5/6 sicl /sl om mfr na na .0 .0
F-1 Boring # Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 •Eff42
F-1 Borin # E] Boring
Depth to limiting factor
g [ pit Ground surface elev. ft. in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 *Eft#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 (R07 /00) Steel's Soil Service, Inc.
• r •
STEEL'S SOIL SERVICE INC 3 of 3
David J. Steel Nels Gronguist 1% 994200 th St.
CST - POWTSM NE1 /4,NE1 /4,S16,T31N,R1XW Baldwin, Wl 54002
Lic. #248956 Town of Star Prairie, St. Croix Co. Direct 715- 760 -0347
MapleHaugen Sub. Lot, 9 Fax 715- 684 -3449
This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use.
The location of this test may or may not be as shown, as permanent lot lines were not established at the
time the soil test was conducted.
Legend N
1 = 40' I
= Benchmark Ele. 100.00 ft
Top of 3/4" pvc pipe
• = Alt Benchmark Ele. 100.00 ft
Top of 3/4" pvc pipe
= Borings
Boring Elevations
B 1 = 99.80 ft
B2 = 9,9.80 ft
B3 = 99.20 ft
B4 = 0.00 ft
93
1
ry ) o LA�
Bz ado n
it
t
/// ' 01
f.,
CN
. t
ti 1� f G')�.
_LOT f
t
X469.63' ` ` o, NMI
N 89 30 25 158.56 . i W o
; 411. \ ;� 1 ,> J ALL LC CL
LINEAR
r
sEARIr
w 1 THE N
ASSUM
00
to d MOTE.
W
I i O IN
J
TER!
V!
j• _ Existing 4 `,1 C) COMP
i 17yewoy to t THIS
4
7
be Retoinearl i I OBYT
I LO
RUNY
NOTE
laws,
-- 960`f 62.16' etc.;
461 , _ Zom
ELE
South . line of the
M 1/4 of the NE 4� CM
%i
r.,
I
I �
9415 AM
A MM pa
Located in part of the Northeast 114 of the Northeast 114 of Section 16, Township Jl North, Range 18 West, Town of Star Prairie, being�Q
Lot 4 of o Certified Survey Mop recorded in Volume 16, Page 4342, of the Register of Deeds Office of St Croix County, r1sconsin.
North I14 Comx Northeast Caner RBG6hASWIFBL'8
Section 16 -31 -18 UNPLATTED LANDS Cmte'1(^e'V section 16 -J7 -18 wwf w
(Esfd47ahed ham ----- - - - - -- 1_a( -N'ay V - - (rand Ahymnwm u
tree a Reca e) _Nam tone o1 We rE -I /+ R county NaWmeot)
N8938'02'E- - - - ` - - N�m'dN9�9Lm0dh
L10THAVEM -N8959'01 E 167499-
\ w v
- - 6s.aD' q
02,45' JJI.JS' !7' - NB9S8'02 j - " 909.70'- , u
_ _NB958'01Y 1649.89- _ 34.31'`` 4 .56'_
589'48'J9 I j 1 �d�
a LOT 1 50' 1 40'I
MIN AVOKI
i o CSM, VOL. 16, _
h � PG. 4342 "� + n
gry - ° o N norm LOT 9 j
Z ono OT 2 \ LOT 8 NIN o
LEGEND I :I +" a CSM. VOL. 16, \ j - 1� °
RECORDED AS 337.21 --- - --- -- }-i N E >
h S89107 337.37' �' p PG. 4342
V
Section Caner Llanummt of Record ; 7 4G N
0 Set 1 -1/4' N 18' Iran rerod -
Weighing 4.3 Ibs/lioew foot
o �u
LOT 1
0 round I O.D. Iron Pipe i I e = g 58650'20 "E 337.06' S I I�
65,778 S0. FT \
0 Found 1 -1 /4" O.D. Iran Frye 9 :m n S1 I j o - N
m 1.5 ACRES :1 br I _ _ o s w i„ s E
.................. Building Setback Line n :n m : rJa1491+r, _ I II _ - I hl, 116 I 11
(50' from R -O -W, 75 from Navigable Wetlands)
n Ui
- • - Proposed Dnve«ay Location ° -
r �
-"' - 12' Utility Easement Line N8T5$24'E :1 n I ` hl VI I I\
-m- Ordinary High Water MarX 339.50 ��.-* II I Q 2 t NOTH AWAA
- - - Edge of Delineated Wetland Are. LOT 7 ��I t cNffy w
Um ,I ddp� I 7TR SEC. 16, 131 N, RIB W.
u Delineated Wetland Areas LOT1 } I �I CAI a TOM OF STAR PRAIRIE, ST, CROIM COUNTY, W
A 69,90650 FT. d f 8 �I m Nmwz"E
H W.I. 25 -year High Water Level o r C1 1 ' '4 c
s \ a 1.60 ACRES b °� d ( Nasigatte Wethond CSI I
999.99 Benchmark (Top of Iron Pipe) a 1 " d eI N n i LOT$ ! W. `?✓ 1 n
133, 417 S0. 7
LBO. Lowest Buiding Opening k i m �I- - - - - - - - I 1 zI
du
3.36 ACRES f
ALL OTHER LOT CORNERS ARE MONUMENTS NTH °j c DI ' ! I Ih . ^ �I U.
1" O.C. N 18' IRON PIPE (WEIGHING 1.13 LB so ° I LOT 6 S. PER r ', +I U NN �I I� v( 0
LINEAR FOOT) UNLESS OTHERWISE SHOWN. 989.9 I �I$ ul H
L 9320' w I 12 h FI
0,shed by Mimi N. Lp" 2 m so LOTS � � I w I v. I �P N I I U 1- I QI BEARINGS ARE REFERENCED TO THE NORTH LINE OF THE
m 19 ,512 $a. fT ° b 9'SBb�E.
o w 4 ro �I I dl NE -1)4 OF SECTION 16, TOWNSHIP 31 NORTH, RANGE 18 WEST,
m 1.83 ACRES . -m ' r m w - - I v Z 1 WHICH IS ASSUMED TO BEAR 118
3 ' L.00,00.7' $I � . -- Q�- - -- DI
m THE PARCELS SHOWN ON INS MAP ARE SUBJECT TO STATE,
n' u COUNTY AND TOWNSHIP LAWS, RULES AND REGULATIONS (LE.
+ N89'33'54'E .° 1_ o i. A � LOT 5 o WETLANDS, MINIMUM LOT SIZE, ACCESS TO PARCEL. ETC).
*"' -N In 367.75 �`� �I - - --' - 2' BEFORE PURCHASING OR DEVELOPING ANY PARCEL, CONTACT
a
; y m " cotk5(y ZI o ,q '. '' \>s I I ��; 1NF ST. CAq% COUNTY 20NINC OFFICE AVD ME APPROPRIATE
TOWN BOARD FOR ADVICE.
*% R QI o LOT41 2 �q�,• m
wD a z a 105,641 So. ET' ¢'
S84'S7'501 q 70i 11, N89'30'25"E 469.63' t ' `i NO OWNER OR RESIDENT SHALL OO ANYTHING WH OH W1A 1D
LwavA6) r WI u 0 71gR 4/ \ 14J ACRES: 8 . 34 6.54' A THE OPERATION OF IHE APPROVED
.,p n lb J4&5 0 411.07 58,}6' a COMPREHENSIVE WATER DRA INTERFERE WIN OR CHANCE
idn faemnf b ^' U THIS DRAINAGE AND SOA ERCSON PUN FOR
C7 +\' m 1/.� 1 � I PUT. THIS INCLUDES BUT IS NOT IWITED TO BUILDING UPON.
�9U QI i °� Qn. 9 NA =9A10' 9 W 9fSJ
' /I` e a LB.Q=95Z0'', , e . & i Y vM1 POND EASEME ALTERING, FlWNG GE OCTC RNG WA ERRING IN ANY
d9 (, � ' ) I I POND EASEMFNR, WATER DRAINAGE °nCHES, WAiEH RUNWAYS,
0 °m 0 '� , JZ 7w o n LOT 9 ° o WATER CULVERTS, BERMS OR GRASS SEEDINGS.
Z ` m SE D' \ .m Iya: 11A91'
\ EAg4 6/ ........ J 'S. "m 61,816 S0. fT. - a H m
Lora . q -
g s.�° ) V � 74,679 sa fr. Tso ACRES
\ /1911 �6 n n I
1.71 ACRES SURVEYOR"$ NOTE: LINOS BELOW THE OAOINARY NGN WATER 140
l ^ 8 -05 ✓ ,�•5j1, S �� ARE Sti TO RIGHTS CG THE PUBLIC UNDER THE PUBLIC IRUST
` ° .bn1 Ark., v (.8.0. =9320' N8910'25 107 DOCTRINE. CONTACT AN ATTORNEY REGAROANG OWNERSHIP AND TITLE
8 b A LOT 5 W r0f 0 ° S S' 460.79' w fT. STARS °F LANDS BELOW WW ORDINARY NIGH WATER MARK. TOTAL
mm h' S S. ; A
90,163 S0. REA NCLUDED :N THE PROPER Y SURVEYED HEREON (ALL FALLING G
yA , U m
z 107 ACRES mar LOT $ �' `� 94.8 Z ry M WITHIN LOT 8), UNDER NAVIGABLE WATER AT THE DATE OF THIS
m 71,866 S0. fT ° LOTD + " SURVEY': 4.21i ACRES
Ion a ion LB.O. =9711' ° H NI
A 1.65 ACRES ^ d 0 0
o 88689 S0. FT. ; o o I
W I swE � \ � � � � 8� 204 ACRES z �
9CAIE N REP: ' IOU het
U f
9SE8 9149 -125755' -
443.49' 353.54' 460.52' ', 62.16'
S8937'53 "W 1319.71' -
I
UNPLATTED LANDS South the of me
CURVE TABLE ---- - - - - -- NE - 1/4 of the NE - ip
CURVE RADIUS DELTA ARC CHORD CHORD BEARING TANGENT BEARINGS hu.
c 167.00' 1'44T alll' 4&64' S09'WMVE SO 141 51724'76 0
C2 ,ar 16'4'19' 6 tO 67. N099Oa"'W N1 'J01Y NCO 2
fJ 233.W 1132'49 71x6 71A6 508'J605S S177230'E 50010'191 l I Prepared for and at
1 51.14' .11C NC89605.5 - W NDDIV191 NI JOW
4591 Wa 2 C4 GS ao.ar 45W'167.°0' 179'49' 0' 6.93' 61.3' 71 - W SOO10'19 544 'SITE Easr 114 coma the request ef:
P,W.d by. Section 16 - JI - 18
�^����^�� C6 BOOR 4511419 62.95 61.37 N22'41 1145101 NO°1019'E (Frond1•IronPipe) OWNER:
J . 8000' 244'06 377.16' I1JW' N89'49'41 5449711 N451C29Y Gary Gronquist
MW Nu (715) 246 -4519 LOT 8 boo 49 '02' 69.71 1 SI 5s0•E •E n'w 416 -8th Avenue NE
9m No (ns) 246 -3M LOT 7 80.W 42 1'55 59.65' 56.41 52nIf06.s'W 50 111 54754'0617
F.0.6mJa 076 6 & 4 aa' 161751 a,ae' sloe' s6ns'o4sW strs4'o6w sa6J6oJ'w Minneapolis, MN 55413
Ne. Rkh-4 W 61017 LOT 5 MOD 1621'17 67,51' 655' 446 1170.7W '38' 'W N '4'W e 5- 248 -7278
SHEET 1 OF 2 SHEETS 01 ono' 9015'13 126.02' 11139 NOOOR S N '4W N4514 9
71
It
ST. CROIX COUNTY
.SEPTIC TANK MAINTENANCE C AGREEMENT
AND -
OWNERSHIP CERTIFICATION FORM
vIailin Address
Property Address Lao
01"crification rt- quired from Planning & 'Zoning Department for new consu
City /State
= =�: '' � s � Parcel Identification Number
LEGAL DESCRIPTION
Property Location ; , / , Sec. (~ N R Town of :Z
Subdivision ,Ae/ ,6/. 1 try Lot #�.
Certified Survey Map # Volume , Page # _
Warratmty Deed # -- — , Volume_ Page #
Spec house yes n - Lot lines identifiable '` 1)0
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 Lank every throe 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.
Uwe, 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. Croiuc.County Planning &
Zoning Department within 30 days of the three year expiratiotl date.
1 /tivc certify 'that all statements on this 10111) arc [nie to tin• best of my /uur knowledge. I /we ani/arc the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number olf be rooms
IGNATURE OF LICANT(S) —� —�
DATE
Any information that is nusrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * **
iiciude 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)
r
G6 Lc / (O F#- z.
1 r 0 Z
7-5 fi Zs - ( 4
553'5 a- Z
,vim a-2.
�� _ -
Z aged 11:80 170 ,
State Bar of Wisconsin Form 2 -2003
WARRANTY DEED
Document Numbcr Document Name
THIS DEED, made between Thomas W. MCCOnville and Mary Tt McCgnville,
husband apd wife
("Grantor," whether one or more),
and Mark E, Rudek and Kathryn M. McConville -Rudek husband and wife
( "Grantee;' whether one or more),
Recording Area
Grantor, for a valuable consideration, conveys and warrants to Grantee the following
described real estate, together with the rents, profits, fixtures and other appurtenant N amc and Return Address
interests, in -. St. Croix County, State of Wisconsin ("Property") (if more space is
needed, please attach addendum):
Lot 9, Maplehaugen, St. Croix County, Wisconsin,
oil- �� -os�ao
Portal Identification Number (PIN)
This is not homestead property.
(is) Cis not)
Exceptions to warranties: Easements, restrictions and rights -of -way rec , if any.
Dated °
j � -r.� (SEAL;,) (S L)
* roar. C Ville by rey Ann on L act
(SEAL} EAL
' *Mu yn MCCO" t by Audrey Ann McConville, her Attoracy -in- tact }
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) 1h omes W, DUConville, by uduy & n
cC v
M onviile h4 _Atto�v_in -Fatj and Mary Jo STATE OF )
ille, by Audrey Ann McConville, her Attorney- )
in- Fact �. COUNTY }
authenticated on
Personally came before me on ,
* Kristine
the above -named
Ottland to me known to be the person(s) who executed the foregoing
TITLE: Mfi STATE BAR OF WISCONSIN instrument and acknowledged the same.
authorized by Wis. Stat. § 706.06)
THIS INSTRUMENT DRAFTED BY: Notary Public, State of
IC
ttorngy ristina 00st1id
My Commission (is permanent) (expires: )
H u d son. 06
(Signatures may be authenticated or acknowledged. Both are not neeessary.)
NOTE: THIS IS A STANDARD FORM, ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY
IDENTI FIED.
WARRANTY DEED 0 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003
Type name below signatures. INFO PRO' regal Fom,s e00-853 -2021 wwwJntopotorni.eon,
s
Zfo / /000 XVd 01 16 noil .aooziVOYGo
I Ll
CT)
LY