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038-1132-10-700
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 572820 0 GENERAL INFORMATION 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: Moen, Chris&Jenel n I Star Prairie, Town of 038-1132-10-700 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: /00.)41 32.31.18.540G TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER le r�1� CAPACITY STATION BS HI FS ELEV. Septic /3w/'f� Benchmark 9vsirig- ,,� Z. i Alt. BM 00 5 l `�(p /�• / AeFeftn Bldg.Sewer Holding 1 St/Ht Inlet 1 l SUHt Outlet �ji/ TANK SETBACK INF RMATION 'y 3 c.-7. 3 TANK TO P/ WELL BLDG. Ven o Air I take ROAD Qt.la tA.,.J /��/ �� ,t�33 Cl•7, Z•1 of /UU 7- J Septic I III I j Dt Bottom ,`,(4 /( 9 Dosing -7g / /f / t' Header/Man. /.1� Aeration Dist. Pipe •�v °� .9 x'.19 Holding Bot.System taqll 93- 9/ 9.17 Q 9�� PUMP/SIPHON INFORMATION Final Grade W, � 1 Manufacturer Demand St Cover GPM `L CO •�� dQ . Model Number ITDH L' Friction Loss System Head DH Ft lForcerR ' Len th Dist.to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length L No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dial_ Liquid&4th DIMENSIONS 47:5 Z '116, U �� SETBACK SYSTEM TO (J P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:Ez ��J INFORMATION CHAMBER OR Typ�Of�System: 1 i 5 7 UNIT Model Number: DISTRIBUTION SYSTE~MJ7— �aJ Header/ManlLif 1,Z ! Distribution Ix Ho a Size x Hole Spacing VertJ�o takg ��T Pipe(s) �� ` ` u /fj LL?� Length Dia Length � Dia Spacing Gi we5 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only B`^ 5 / Depth Over Depth Over xx Depth f xx Seede odded xx Mulched J Bed/Trench Center � 7- Bed/Trench Edges Topsoil J es No � Yes No 2p COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 1827 Winding T ail�Rpi�dGNew R�monJ� 54017(NW 1/4 SW 1/4 32 T31 R1 8W) NA Lo 8 L Parcel No: 32.31.18.540G 1.)Alt BM Description= f�+-j tt''t �,,�r. �' d�+t�• S 2.)Bldg sewer length -amount of cover= 1t Plan revision Required? ❑ Yes No !6 Z-7 Use other side for additional information. SBD-6710(R.3/97) Date Insepctor's S' nature Cert.No. PLOT PLAN N NProject Name: Moen Replacement Septic System Legal Description: NW1 14,SWUM,S32,T31 N,R18W PAD: 038-1132-10-700 Subdivision Name: NA Lot* 8 SCALE:1"=40' Township: STAR PRAIRIE Parcel Size: 2.00 Acres County: ST.CROIX System Elevation: T1=92.66' Existing 68.75'Inf.High Cap.Trench Slope: 8% T1=92.66' Existing 68.751 Inf.High Cap.Trench A BM1 Elevation: 100.14 Top of Septic Tank 1 manhole cover T3=93.70'Proposed 90'EZ Flow Trench BM2 Elevation: 100.00 Top of Foundation T4=9 50'Proposed 85'EZ Flow Trench Backhoe Pits: 14 inch Sch 40-ASTM D2W, ST' Wieser Concrete 1000 gallon with Zabel A-100 filter 14 inch 3034 - ASTM D3034 ST2 Wieser Concrete 1000 gallon with Polvlok 525 filter NOTE:See page 11 for a complete plot of the parcel. J �z�us►_ T 1` - ---------- GAO&E z v< STS 5`�Z � d j =age 2 �� County ", tl� Safety and Buildings Division 5 . C � �� i p `� 201 W.Washington Ave., P.O.Box 7162 Sanitary Permit Number(to be filled in by Co.) $ SCE k Madison,WI 53707-7162 RECEIVE S 7Z `6Z(D Sanitary Permit Applicatio State Transaction Number ' � ac 20n ��- In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the priate governmental unit is required prior to obtaining a sanitary permit. Note:Application forms for stat - itted to Pro,1�ct Address(if different than ling address) the Department of Safety and Professional Servies. Personal information XOp�Md,d s R fy o /TO'7 �� /��t purposes in accordance with the Privacy Law,s.15.04 1 m,Stats. M U Iv 7G' I. Application Information-Please Print All Information Property Owner's Name Parcel# ()IRIS ANIQ J Y AJ /1 D c Jl� D3 8 -/ Property Owner's Mailing Address '77 Property Location /e Z / V to& Govt.Lot City,State Zip Code Phone Number/, s W Section 3 ` . ' �l C t4 110 JV d , ,) .5 L/D 7 circle one !iV lit/ T�N; R�E o� II.Type of Building(check all that apply) Lot' Y1 or 2 Family Dwelling-Number of Bedrooms L Subdivision Name �r�I4G��M.C� Bloc (((/// ❑Public/Commercial-Describe Use ❑ City of El State Owned-Describe Use / CSM Number D l ❑Village of �1 Z �1',o [ t-tJ $.5 f' / t=Z �/�.JS 39 5 �P6571 1 �Town of ��r7 I P ���/�/� III.Type of Permit: (Checlt only one box on line A. Complete line Bjf applicable) 20 AO- A. ❑New System �R e lacement System ❑Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(explain) B. ❑Permit Renewal El Permit Revision ❑ Change of Plumber List Pre vi us Permit Number and Date Issue P El Transfer to New --� Gpj q ��� , �� �0 2� Before Expiration Owner C / IV.Type of POWTS System/Component/Device: Check all that apply) Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑Mound<24 in.of suitable soil ❑Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) V.Dispersal/TreatUKnt Area Information: Design Flow(gpd) Design Soil Application Rate(gpd Dispersal Area Re uired(sf) Dispersal Area Proposed(s System Elevation r boo 0, 7 8: 6 7 :5 9 'I� VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units °o C.7 V H New Tanks Existing Tanks 2 0 34 U a U in y cn w c7 a Septic or Holding Tank (7�O / Q 0 Z 000 Z / e3 t e C D u<,e x Dosing Chamber VII.Responsibility Statement-I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber' gna a MP/MPRS Number Business Phone Number ©1H4iU Sc1pit/ Ct ZZ37i!� D 71-1'>-- 7&0-0e10Q6 Plumber's Address(Street,City,State,Zip Cole) _ VIII. un /De artment Use Only XP—Proved ❑ lsapprove Permit Fee Date I ued Issuing ent Signature ❑ O tven Reason for Denial IX.Condi$ W(Reasons for Disapproval 11 pp I t I '$eptk1ank,effluent filter and �J dispersal cell must all be serVtees f m�itainetl J/� as per management plan provided by plumber. �p r,nom, t f t) ► Abp r " 2. s00w1 k; tretnenis<must befrtftaintalned U as W vpokililkctide%ordinonoa. Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398(R. 11/11) i CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Moen Conventional In Ground Owners Name: Chris&Jenelyn Moen Owner's Address 1827 Winding Trail Road New Richmond, WI 54017 Legal Description: NW1/4, SW1/4, S32, T31N, R18W Township Star Prairie County: St. Croix Subdivision Name: Lot Number: 8 Block Number Parcel I.D. Number 038-1132-10-700 Plan Transaction No. Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing &Cross Section Page 4 Septic Tank Specifications Page 5 Filter Information Page 6 EZ Flow Installation Instructions Page 7&8 Management and contingency plan Page 9 Septic Tank Maintenance Agreement Page 10 Warranty Deed Page 11 Aerial Photo Page 12 CSM or Plat Attachment Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date: 10/14/2014 Phone Number: 715-760-0486 1 Signature: In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) Page 1 PLOT PLAN N Project Name: Moen Replacement Septic System Legal Description: NW1 14,SWIM S32,T31N,R18W P.I.D: 038-1132-10-700 Subdivision Name: NA Lot#: 8 SCALE:I"-4O' Township: STAR PRAIRIE Parcel Size: 2.00 Acres County: ST.CROIX System Elevation: T1=92.66' Existing 68.75'Inf.High Cap.Trench Slope: 8% T1=92.66' Existing 68.75`Inf.High Cap.Trench A BM1 Elevation: 100.14 Top of Septic Tank 1 manhole cover T3=93.70'Proposed 90'EZ Flow Trench BM2 Elevation: 100.00 Top of Foundation T4=9 50'Proposed 85'EZ Flow Trench Backhoe Pits: 14 inch Sch 40-ASTM D26c ST' Wieser Concrete 1000 gallon with Zabel A-100 filter i 14 inch 3034 - ASTM D3034 j ST2 Wieser Concrete 1000 gallon with Polvlok 525 filter NOTE:See page 11 for a complete plot of the parcel. J N v u5 E T DRIVE _ GAO&£ o n 2 J W�zLL X � ST� 1- 5r Z � 96 Z-1 g3o ED r i gage 2 SOIL ABSORPTION SYSTEM DETAIL/ GRAVELLESS LEACHING UNIT Project Name: Chris&Jenelyn Moen Gravelless Leaching Unit Specifications Manufacturer Model Laying Length EISA Rating Infiltrator EZ1203H-5ft 5.0' 25.0 EZ1203H-10ft 10.0' 50.0 System Sizing EISA Rating per Foot of EZ Flow 5 ft2 Soil Application Rate 0.7 gpd/ft2 600.0 gpd Design Flow_ 0.7 Soil Application Rate_ � EISA= 171.4 Feet of EZ Flow F 27 trenches 85&90 feet long 2 No. of Cells 8.5 &9 Per Cell 3 ft Cell Width 17.5 Total No of 1203H 85&90 ft Cell Length 425&450 sq ft EISA Per Cell 3 ft Cell Spacing 875 sq ft Total EISA Typical Cross Section Finished Grade 97 ft Observation Pipe with approved cap or vent ~l" • --� Soil Backfill ■ 36 inch -- Geotextile Fabric 12 inch (I Slotted and Anchored VentlObservation Pipe with Cap 94.50 ft 93.70 ft Infiltrative Surface >36 inch 88.27 ft Limiting Factor o n e s•a■a■•a••....-rT_____.87.60 ft Limiting Factor ■■■�7T�■■■r■■■■■a■■ar■■■■aa■■a■■■■■■■r■■a■■■ Plumber/Designer Signature: License#: MPRS 223760 Date: October 11, 2014 gage 3 M-WkM :311A 99_v2_9z2_009 OIOZ 'N`df 03SLA38 Z \ anod-lsod 31Va otoa kNvnNVr :3tva osLt, IM ')4008 N3oIVW of ,IMH sn 9LLCM �`dnN`dW OI1d3S z LLJ o LLJ 21nOd-38d .o-,l= 4 l 31VOS 3WS l8 NMdMa 3138D oil 13131M 0_000W-M N �- Z W W •• .-. Q O p 0 W JW TU H > 0 R' � Q °o o M cn '�` v a m m UI M o pr WW_ J WoW to W DC Z r Ufa W H J ^ J 1� 0 ? J Q �y Q 0 N O\ O m 0 o� C7 O 21X U ..0 r*Of v W M F'J Z x 'C 00 Q 0 Z m V ~ H W W w 0 0 Q Wa OQ Q-U J DO o 0 Q O ON Q Q W N f- a WO fd I U a �. � p ca WW O p� O WZ3O3 0� U m Ln m z > LL MC7 DOw � a s m Np� J4W nWVI M a > F w cn 0 O O > (� UZ _UV 00N� MJ WFI mWw� � aU O W QZ _p qZ�Y n V ^ Q a a Q U = a 9 d W►-a O •• OQ1 H N N to F- N Q oo p Q C Z' uj F- C Q a r w \WO N gOa ~J^ QV Z�- } pQ a. x CC")M: 5 ZY 0- N a .D la '-Ct00 Z t0 8 f_ N N F- x U UZ' j O N N Q J N � .. —� .. �QW �Z� U ZH -� to Q WU WpW F-I IN ..O 3D~ Y 0W Q Q Q W x3 mF O w= Y OQO OQw ZOWO Zc,Q ZQO U pU G7 Y� Z ZW 2x N� Z Nam U�x *m=,w3 Qac� Q$., zoa Z z$ a v� p Q W I' H ? O p Z Z OJ Z Q OQ p f. U H U W 0 Z Q x X W w O O R N U_ Q i C) J M N Q j0 W U 0 Q D ? „6C Q W 4. 0 O D w � ONLY. W CL 2 a W I n N N_ Svo „- I U_ U a aw s „8F do 3 3 s N J m W I Q I l S 0 a ui W of O X ` Q I t- U / W d a Syo „. � 1 nl / F- t� do 9 u W �� 1 0 *� N w W a. J R Z U Z Q „99 L9 W ir Q N Z FQ•• "'age 4 3XInc. Innovations in Precast Drainage � Zabei® PL-525 Effluent Filter &Wastewater Products A Division of Polylok Inc. PL-525 Filter The PL-525 Filter is rated for 10,000 GPD(gallons per day)making it one of the largest filters in its class. It has 525 linear feet of 1/16"filtration slots.Like the Polylok PL-122,the Polylok PL-525 has an automatic shut-off ball installed with every filter. When the filter is removed for cleaning,the ball will float up and temporarily shut off the system so the effluent won't leave the tank. I Features: 1A6" Filtration Slots Sw • Rated for 10,000 GPD(gallons per day). -- oia>H itch • 525 linear feet of 1/16"filtration. �� G 13 (optional) • Accepts 4"and 6"SCHD 40 pipe. Accepts 1"PVC P p p Extension Handle • Built in gas deflector. • Automatic shut-off ball when filter is removed. • Alarm accessibility. Rated for 10,000 GPD • Accepts PVC extension handle. PL-525 Installation: Ideal for residential and commercial waste flows up to 525 Linear Ft. 10,000 gallons per day(GPD). of 1/16"Filtration Slots 1.Locate the outlet of the septic tank. 2.Remove the tank cover and pump tank if necessary. r 3.Glue the filter housing o the 4"or 6" outlet pipe. If Accepts 4"&6" ' g p�p � SCHD 40 pipe 1 � ` 4• the filter is not centered under the access opening use a Polylok Extend&Lok or piece of pipe to center filter. 4.Insert the PL-525 filter into its housing. i 5.Replace and secure the septic tank cover. certified d to p P � NSF/ANSI Standard 46 PL-525 Maintenance: The PL-525 Effluent Filters will operate efficiently for several years under normal conditions before requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped,or at least every three years.If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing.Servicing should be done by a certified Gas Deflector I septic tank pumper or installer. Automatic Ball 1.Locate the outlet of the septic tank. Shut-Off 2.Remove tank cover and pump tank if necessary. 3.Do not use plumbing when filter is removed. 4.Pull PL-525 cartridge out of the housing. 5. Hose off filter over the septic tank. Make sure all F solids fall back into septic tank. ` 6.Insert the filter cartridge back into the housing making Isure the filter is properly aligned and completely inserted.inserted. Outdoor SmartFilter®Alarm Extend&LokTM Polylok,Zabel&Best filters accept Easily installs 7.Replace and secure septic tank cover. 1 the SmartFilter®switch and alarm. into existing tanks. Polylok,Inc. 3 Fairfield Blvd. Wallingford,CT 06492 Toll Free:877.765.9565 Fax:203.284.8514 www.polylok.com 'aae 5 Wisconsin Department of Commerce,Safety and Buildings Division, 5. The Absorption area (SF) necessary for a given site shall be has reviewed the specifications and/or plans for this product and sized based on maximum daily sewage flow (GPD) and the determined it to be in compliance with chapters Comm 82 through P P 9 Permeability for the site. If certain criteria is met, the EISA 84,Wisconsin Admin.Code,and Chapters 145 and 160,Wisconsin sizing can be used in Wisconsin, resulting in a 40% smaller Statutes. All sites must meet the Site&Soil Conditions&Locations &Isolation distances as noted in local regulations. dramfield. The approved products are 1203H (3-12" bundles with pipe in cen- 6. Place EZflow bundle(s)in the EZflow configuration approved ter bundle in 5'or 10'lengths)and 1203HP(3-12"bundles with pipe by system design permit specified for the particular site.The in each bundle in 5'or 10'lengths. top or center-most bundles containing pipe are joined end to A single pipe bundle contains a four inch perforated pipe surround- end with an internal pipe coupler. Any additional aggregate ed by EPS aggregate and is held together with polyehtylene net- only bundles that may be required,should be butted against ting.A single aggregate bundle contains aggregate only and is held the other aggregate-only bundles and do not require any together with polyethylene netting. type of connection. Materials and Equipment Needed 7. The to of each GEO cylinder contains a filter fabric re-manu- P Y P • EZflow® Bundles factured in between the netting and aggregate. The fabric • EZflow Geotextile Fabric is inserted to prevent soil intrusion. The installer shall make • EZflow Internal Pipe Couplers sure the the GEO is positiioned upward and is in contact with • Pipe for Header and Inlet the fabric contained in the adjacent cylinder before backfill- • Backhoe/Excavator ing. Installation Instructions 8. The EZflow Drainfield Systems should be installed in a level The instructions for installation of EZflow® products are given be- trench in all directions (both across and along the trench low. This product must be installed in accordance with state rules bottom)and should follow the contour of the ground surface defined in chapters Comm 82 through 84,Wisconsin Administrative elevation (uniform depth), with all continuous adjoining Code,and Chapters 145 and 160,Wisconsin Statutes,as well as the 10-foot cylindrical bundles placed end to end, with central local health department's current design manual. bundle distribution pipe interconnected, without any dams, stepdowns or other water stops. 1. After the local health department has determined sizing,con- figuration,and layout for the EZflow systems,stake or mark 9.The trench top shall be graded such that water will not pond. with paint the location of trenches and lines.Be careful to set Backfill should be seeded or sodded immediately after correct tank, invert pipe, header line or distribution box and completion to reduce erosion. trench bottom elevations before installation of pipe bundles. 10.EZflow EPS bundles are flexible and can fit in curved trenches 2. Remove plastic EZflow shipping bags prior to placing bundles as may be necessary to avoid trees, boulders, or other in the trench(es). Remove any plastic bags in the trench be- obstacles. fore system is covered. 11. EPS aggregate is lighter than water, therefore, it might be 3. This product must have geotextile fabric that meets require- expected that natural buoyancy forces would tend to cause ments of s. Comm 84.30 (6) (g), Wis. Adm. Code, installed EZflow assemblies to float out of ground when ponding oc- directly on top of the product and extending down along the curs. Field experience has shown, however,that this is not a sides of the product to a point at least six inches from the problem when systems have a minimum of 6"of soil cover as bottom of product. recommended by manufacturer. 4. When installed in a trench, the trench should be dug to a 1203H-GEO width of 36 inches. This not only saves labor in excavation, Geotextile but also provides better load-bearing capacity after backfill- Barrier Material ing is complete. �Z° JON QNI BUNDLES WITH NIFRNAL F&E COIJPLW6 EZ flow Ring Industrial Group P: 1-800-649-0253 30 Industrial Park PERFORMANCE. Ez DOES IT.. F: 1-866-279-9203 Oakland,TN 38060 Ringlndustrial.com 1044-101008 ©2006 Ring Industrial Group,LP Rage 6 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page_of FILE INFORMATION SYSTEM SPECIFICATIONS Owner: Chris&Jenel n Moen Tank Manufacturer: Wieser Concrete r NA Permit# 11 Septic r Dose Holding Volume: 1000 gal DESIGN PARAMETERS Tank Manufacturer: Wieser Concrete r NA Number of Bedrooms: 4 NA 8 Septic E Dose Holding Volume: 1000 gal Number of Public Facility Units: NA Vertical Distance Tank Bottom(s)to Service Pad: ft Estimated(average) Flow: 400 gal/day Horizontal Distance Tank(s)to Serivice Pad: ft Design(peak) Flow=estimated x 1.5: 600 gal/day Specific servicing mechanics must be provide if vertical is>15 feet or if In Situ Soil Application Rate: 0.7 al/da /ft2 horizontal is>150 feet.Specific instructions to be provided on back. Standard Domestic Influent/Effluent Monthly average Effluent Filter Manufacturer: Zabel/Polylok r NA Fats,Oils&Grease(FOG) 530 mg/L Effluent Filter Model: A-100/525 Biochemical Oxygen Demand(BOD5) 5220mg/L NA Pump Manufacturer. OF NA Total Suspended Solids(TSS) 5150mg/L Pump Model: High Strength Influent/Effluent Monthly average Petreatment Unit Fats,Oils&Grease(FOG) 530 mg/L Manufacturer: Biochemical Oxygen Demand(BOD5) 5220mg/L W NA r Mechanical Aeration r Peat Filter NA Total Suspended Solids(TSS) 5150mg/L r Disinfection 17 Wetland Petreated Effluent Monthly average r. Sand/Gravel Filter r Other: Biochemical Oxygen Demand(BOD5) 530mg/L Soil Absorption System Total Suspended Solids(TSS) 530mg/L 01 NA IN In-Ground(gravity) r In-Ground(pressure) r—NA Fecal Coliform(geometric mean) 5104cfu/100m1 r At-Grade r Mound Maximum Effluent Particle Size: Ya in dia N r Drip-Line r Other: Other: Other: NA MAINTENANCE SCHEDULE Service Event Service Frequency When combined with sludge and scum equals one-third('/)of tank volume Pump out contents of tanks When the high water alarm is activated month(s) Inspect condition of tank(s) At least once every: 3 gR year(s) (Maximum 3 ears) r NA month(s) Inspect dispersal cell(s) At least once every: 1.5 1p year(s) Maximum 3 ears F NA month(s) Clean effluent filter At least once every: 1.5 year(s) r NA month(s) Inspect pump, pump controls&alarm At least once every: year(s) Pr NA month(s Flush laterals and pressure test At least once every: year(s) W NA month(s) Other: Ca trenches T1 &T2 Use T3&T4 for 5 year(:) NA Other:Alternate Trenches Alternate Trenches every 1.5 years MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:Master Plumber;Master Plumber Restricted Sewer;POWTS Insepector; POWTS Maintainer;Septage Servicing Operator(pumper).Tank inspections must include a visual inspeciton of the tank(s)to identify any missing or broken hardware,identify any cracks or leaks, measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on ground surface.The dispersal cell(s)shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface.The ponding of effluent on the ground surface may indicated a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumualtion of sludge and scum in any treatment tank equals one-third(%)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 Admininistrative Code. All other services,including but not limited to the servicing of effluent filters,mechanical or pressurized components,petreatment units, and any servicing at intervals of 512 months,shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. (Rev.2/05) Rage 7 Page of START UP AND OPERATION For new construction,prior to use of the POWTS check treatment tank(s)for the presence of painting products,solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil dispersal cell(s). If high concentrations are detected have the contents of the tank(s)removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During extended power outages pump tanks may fill above normal highwater levels.When power is restored the excess wastewater will be discharged to the dispersal cell(s)in one large dose and may overload them resulting in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells.Do not drive or park over,or otherwise disturb or compact,the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics;baby wipes;cigarette butts;condoms;cotton swabs;degreasers;dental floss;diapers;disinfectants;fat;foundation drain (sump pump)discharge;fruit and vegetable peelings;gasoline;grease;herbicides;meat scraps;medications;oil;painting products; pesticides;sanitary napkins;tampons;and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33,Wisconsin Administrative Code: •All piping to tanks,pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed. •The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. •After pumping,all tanks and pits shall be excavated and 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 the opportunity to obtain a sanitary permit for a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure,lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology,a holding tank may be installed as a last resort. ❑ The site has not been evaluated to identify a suitable replacement area.Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area.If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING: TREATMENT TANKS AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES AND LACK SUFFICIENT OXYGEN TO SUPPORT LIFE.NEVER ENTER A TREATMENT TANK OR HOLDING TANK UNDER ANY CIRCUMSTANCE.DEATH MAY RESULT.ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK IS VERY DIFFICULT. ADDITIONAL INFORMATION: POWTS INSTALLER POWTS MAINTAINER Name:John Schmitt Name:John Schmitt Phone:715-760-0486 Phone:715-760-0486 i SEPTAGE SERVICING OPERATOR(PUMPER) LOCAL REGULATORY AUTHORITY Name:Owners Choice Name:St.Croix County Zoning Phone: Phone:715-386-4680 This document is intended to meet minimum requirements of Ch.Comm 83.22(2)(b)(1)(d)&(f)and 83.54(1),(2)&(3),Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. =age 8 Ilflllllllll1111111111111111III 8 Tx44197241 5 State Bar of Wisconsin Form 1-2003' 998154 WARRANTY DEED BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI Document Number Document Name 07/03/2014 10:21 AM EXEMPT#: N/A REC FEE: 30.00 THIS DEED,made between Stephanie S Potter,a single person TRANS FEE: 750.00 ("Grantor,"whether one or more), PAGES: 2 and Chris Moen and Jenelyn Moen,Husband and Wife as survivorship marital property "rGrantee,"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 Saint Croix County,State of Wisconsin("Property")(if more space is needed,please attach addendum): Name and Return Address See attached Exhibit"A" Chris Moen and Jenelyn Moen 1827 Winding Tr Rd New Richmond WI 54017 038-1132-10-700 Grantor warrants that the title to the Property is good,indefeasible in fee simple and free Parcel Identification Number(PIN) and clear of encumbrances except: This _homestead property. (is)(is not) Dated —�s[.A, tiL �J , C'W UJI0001IM 10 e1D1S 0114nd AJD10N * StephaAe S Potter ONII83M I NV11V * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) authenticated on C r6 t)� )ss. G7 COUNTY ) * Personally came before me on -Siti L)k_ 25 , ao(� , TITLE:MEMBER STATE BAR OF WISCONSIN the above-named Stephanie S Potter,a single person (If not, to me known to be the person(s)who executed the foregoing authorized by Wis.Stat.§706.06) in eta ckno dged a same. THIS INSTRUMENT DRAFTED BY: s Ancona Title&Escrow Notary Public,State of Wisconsin 4750 White Bear Parkway,White Bear Lake,MN 55110 My Commission(is permanent)(expires:7/^21 1'7 /' ) �O C11160-41 (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE:THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED 0 2003 STATE BAR OF WISCONSIN FORM NO.1-2003 SFyRra#�C� �9�164 Page 1 of 2 Escrow File No.: 1418319 EXHIBIT "A" Lot 8 of Certified Survey Map filed September 27, 2000, in Vol. 14 of C.S.M., pg. 3956, as Doc. No. 630591 located in part of the NWY44 of the SW'/ of Section 32, Township 31 North, Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin. i St. Croix County 998154 Page 2 of 2 i I V'3A� '�' ega rX.!AX)W OV ' � _ .— LA-v w .r LSH �=cc� o c4i :TW�i QQ*GS w�s SLCIOOCCo„WI m=~” o ��RTIFIED SURVEY MAP _ G k� 5 :& x �W� LOCATED IN PART OF THE NW1/4 OF THE SW1/4, SECTION 32, T31 N. R7 8W, TOWN OF STAR PRAIRIE, ST. CROIX COUNTY, WISCONSIN. OWNER RUSSELL FLANDRICK RR 4 BOX 162 NEW RICHMOND,WI 54017 CURVE DATA NUMBER RADIUS CENTRAL CHORD CHORD ARC TANGENT TANGENT ANGLE BEARING LENGTH LENGTH IN OUT © 233.00' 17°8761" N 10'23'57.5"E 72.78' 73.08' NIW22'83'E N01"28'02'E 616' M L�n1 GPdGQ4'4L C�7 �QMr.©� I W1/4 CORNER °I 21 01 ©_ ' l[`I.ILSDD D�'I [�dLQ�44L5G3 T SECTION 32 091 or I 689 035'39"E 299.30' o- I fI _ a o _ Cn _ 3 W °I O 1 �I ZI N 0I u b n dlAI �! e ti a 117 9) I z �I Iz[ 10,- LOT 8 N 1 N J �sas°29'2r'E 649.80 39. 7" 2.00 ACRES 87,120 SQ. FT. wZ N I �I C' hm ¢moo $ " Ilal A Lu o c o ( I I 2 N89°35'39"NN 329.16' Z= 01 �� -A, oI I 33 33' 101T (5 �°�cIIUIJo lSW CORNER SECTION 32 o — Z ° LEGEND APPROVED o ST.CROIX COUNTY w Planning Zoning and Parks Committee ALUMINUM COUNTY SECTION CORNER MO UMENT OUND SEP 2 7 2000 o1^IRON PIPE FOUND If not recorded within 30 days of LU 0 1"X 24^IRON PIPE SET WEIGHING tai date approval shall be 0 and void 1.13 LBS.PER UNEAR FOOT null 100'ROADWAY SETBACK LINE r 1 1/4"IRON REBAR FOUND SCALE IN FEET 1" 100' a= ? 100 0 100 200 Cn 2 r Vol.14 Page 3956 r h ~ O O t d > o �i bo N a R' 0 �0 O � I N � I •� I N O 0 a 0 w �rn I o N I N 0)LO N y ,a O O O .0 Z w Z 0 c o a) v c ' v I I o c E Q W Q o v M C y Z N M M H Z a m a m I I o Z :4� c 3 r o � w 0 o u. r o '0 (D Z � � W E E N N C - a 0 _ c H N O O co n aD d o m ° • o d m L a L 0 o O O ` Q p t- Q 0 y N z C7 z z - Z Z Z N w °_ w cD 'a c LL c c Cl) L R i � 'ooa a � t h� Q p Z (ttA to N v t� N M N p •N a. CL za. an. V1 J U rn o ° Z o °O a•'i �y N_ •� CO O O �_ N_ Cl) v C ° _° Z 0 0 0 0 0 0 0 S _ H r �l N M S O 0 G ° _ (' E N N N N N N :t:!l N �- •� '0 '7 O N 0 N M n N M N CD CO m C m (UD co (D 4) CO N Q O1 N � A , � a� ¢ z v� I � � � ¢ n in a v o 0 3 c c a c r.+ Ur O ojf O w0 L O 7 tl! > V M - - fD N E y E T m N N N N N N N ` c6 ~ O ` w (7 C 7 N M n N M N Ci CL C N N N C '06 N N H N c r (G (O CD W) co Co d I-�I M N a+ 7 f4 Y+' O +O'' 7 t `- • Cl) M f/� U- O z y a' z d M C, �Z' N Z Y " U) r.a € a a • CL 2 d a c as a c r`1V o '0 o r A v a t O v) v O p) U Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 399526 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: Potter, Timothy Star Prairie Township 038 - 1132 -10 -000 CST BM Elev: r Insp. BM Elev: BM Description: OD -( �. TANK INFORMATION EVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic t Benchmark I UD - Dosing Alt. BM 3 " /, / 4 $ r Aeration Bldg. Sewer � / �'8.98 Holding St/Ht Inlet ° 9� •SZ' TANK SETBACK INFORMATION SUHt Outlet , 7-Z y� TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic , t t 2 -4 r Dt Bottom Dosing Header /Man. 1 Aeration Dist. Pipe * I C +bb Q3 +�� •6 L Holding Bot. System -cl �, r PUMP /SIPHON INFORMATION Final Grade h� , Manitfacturer Demand St Cover f Model N ber TDH tift Friction Loss System Head TDH t Fr56main Length Dia. Dist. to Well SOIL ABSORPTION SYSTE 131111111111C Width + Length INo. Of Trencheh PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIME19STM 3 �rS•�r�, 6Z) SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufa INFORMATION CHAMBER OR l Mme✓ ► �R/ Type Of System: t f UNIT MoqekNum Co Kv. 10 CA DISTRIBUTION SYSTEM lam-6 f, Header /Manifold ! Distribution x Hole Size x Hole Spacing Vent to Air Intake cy Pipe(s) > ' �, Length Dia l 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 lBedfrrench Center Bed/Trench Edges Topsoil Yes ❑ No i ❑Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) Inspection #1: 0 / 1�/ e( _' Inspection #2: / Location: 1827 Winding ngTrail o Star P airi WI 54028 (NW 1/4 SW 1/4 32 T31 IN R1 8W) NA Lot Parcel No: 32.31.18.540 1.) Alt BM Description - f 2.) Bldg sewer length = 2� - amount of cover - « agig Plan revision Required? ❑YesNo t _d ' I,1� ) e gth�r si a fQr addition � al i m �` !tom✓ • Date �2-z, I �SSD -6 67 x 1 s 0 (( R.3/97) — too , Insepctors Signature Cert. No. ('� S) A6 wit. «A- soy �.a„e cam U21. wts. Co* got W. w AwL . Flt o�.�"Noft FORM 7302 . " wdft )"Pwdft aq► boom hr ae RIM p Mme. wt 33707-7= ti'et ► t.aw, t (Si hm to eouisty . t smt ow" 14 Ixt 3 s tdnt an hepeey, 14ms - � , � � � `` � �► , " �aebr taa�atiae LK (y CIWI nnni •ice -(Cbuk y 9 b D da wek,. ffk te,`�p -�� —s Q cIw ;fe <JLQ1` t s as G Le A ' ei _ - ) 1 _ u oft boban as on e tic brat ere tiro �' —Y 6o g, Taak S. El Addidm to '- T3►Fa Or"WT ; ocho* as t8rt apptfr3 Dt D tea D %ad FMw D C=Sbvmd *%d ad 13 D nt TM& D to pD Ddp Lim V. .+n. ° Tkmaaat t D 1 .s Ir V14 tank ►fir ToW • of Saar rn" 8ka ft PMbai► lh�e ernsa�e Mae: Tama tf.- tom. aaies CIM :aw�od S. 14� D D D D D � of tl�s t tMrr�s Wo aneai�od yh D EX. Crne tin �T kA � �lMkllesQoawd4de� dM�wed c O Abaft= aw ZzS oc� l a zv�/ Gl fi (�Gr jp �2 NCQiiLl2� � ��S�rvlGc 1 �+^- �- 1.1,7 6^�GOmn,ev,e��i►s_ i mom}� J +if, IN f. A A o oo EJ tF� _ ; f� Alt a n ` . G� ! 24 map S " r o S�� � �nQ V11,41., (0� 17 -S E 1 -[ .1 �6r�ti 44 37 co- 6c (_ _ l _41 �d �s /� A j n P�-c Pvo-r mo J t'a -ems N w 4 4 - S �l � S 3 a - 3 I t3 j g.r�1 EI S TaP •.�'Q i O oo a V r , � C- /Z -C.L6� .. L� �f �(►� . �� ��� -�f a - t v-�.W C �11� � - 7 s E� 9Q, to a 99� �6r�ti 3 . 7 , (0- 15 I r 1 S U / 5� i r IMAUI �d - 7 x ti C- E x a c Q 3 O C .- _ i Qf .� a� v ctU-_ C �do � S � x i N `) J cp o O :C vs (A US t ' Fan v . i 4 t � V i S • p = i V vl j;i i cc 1L f� cl w , tCS U 1 r y xT 4 . Wisconsin Department of Commerce SOIL EVALUi -,TION REPORT Page of Division of Safety and Buildings in accordance with Comrp•8b, Wis.; Adm. -Code ' County Attach complete site plan on paper not less than 8 1/2 x 11 indhes' in size Ian must f include, but not limited to: vertical and horizontal reference olnt (9M), dirdW�o(� d 'parcel I.D. percent slope, scale or dimensions, north arrow, and locat"d dis �1►7 6 st road. r� ftoviewed Date Please print all informal ,,+r�i� r � { tin.; ✓ � Personal information you provide may be used for secondary pudposat (Priv y Gp , N 15.04 �) (m)). Property Owner ?!Location 2 / l /4� /4 S_ A T /� N R! E(or W Property Owner's Mailing Address % ` Lot # Block #,' Subd. Name or CSM# City State Zip Code Phone Number '0 tom" Q Village Town Nearest Road t,.,) W S Y 07 1( -37 1 lqs ` K New Construction Us Residential/ Number of bedrooms Code derived design flow rate � _ GPD ❑ Replacement e Public o� commercial -Describe: Parent material Gc?I lip Flood Plain elevation if applicable ft. General comments and recommendations: ( .• FT Boring # El Boring � 6 — �-Pit Ground surface ele . ft. Depth to limiting factor 7� — in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 92 . Py N rzo ® Baring # I ❑� Boring � pit Ground surface elev. I ft. Depth to limiting factor Z4211:1? Q11:1? in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 3 ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L ame (Please Print) Si nature CST Number ate- 0 �Io� Address Date Evaluation Conducted Telephone Number Od / Z JZ, i � I" ,- , -o0 1 d=a d Y �1(, I Property Owner Parcel ID # Page of F3-1 Boring # � Boring n t 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 1 2 - 2Z - ae l a F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. -- go — ilApplicabon 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 ❑ 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 Effluent #1 = BOD, > 30 < 220 mg(L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/- 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) Soil Test Plot Pla Project Name Russel Flanddck Sha ird Address 1823 Winding Trail Rd. New Richmond Wi 54017 CS M #226900 Lot 8 Subdivision ------- Date 8 N W 1/4 SW 1/4S 32 T 31 N/1318 W Township Star Prairie ❑ Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post System Elevation 92.6 *HRPSame as Benchmark Alt. BM Top of Survey Pipe @ 97.6' Alt Winding Trail Rd. SB.M. 0' 25' B -2 8% Slope 40' 20' -3 0 4 c o 0 M B -1 97.0 99.0 a� 0 a 101.0 a� 0 0 M M 285' Property Line oa 1,KA W LUNING 0001 ,� •. �. Private 4nsite Wastewater Treatment System Management Plan Septic Tank And Gravity in- Ground Soli Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code eater PrOate Onsite Wastewater Tmatment System (Powrs) shah include k tarmftn and procedures for maintaining the system vimin the Paremetaers of Comm 83 and 84, and Vw conditions of approval by the or governmental unit. The aroved plans and le ar Permits for system e on file at c n a ty gerrt, pp zoning or health department. Sod This management Pion complies with Cw= 81%. Wis. Adm. Code, and the in- (around n Component Manual for Private Ormft Wastewater Treatment Systems SBD- (11-81%). Tabht 1: system n Number of Permit Fltar %drooms 3 Design Flow - Peak ( ) Estattaded Flow - A ( Soft Tank Soft Size T � Wastewater Do<hestic TOW 2: Soil Abe C on t hWft of RefNrbta OPWOOM Flow ' Pbhtc To Q MaxwAim Componeii Sod Absorption lnfiuerd Pattide Sizie 118 Ma>�'num 220 Mean TW ( 150 T" 3: Makdogwnce Srhreduk Tank and/or service once ovey 3 years Outlet iffier lnWW once a year and dean at least once 3 yews oreca ova y 3 Veam The septic tank shah be maintained by an individual c artified to service septic tanks under s. 281.48. Stets. The contents of the septic tank sW be disposed of in awordanc:e with NR 113, Wis. Aden. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease � ► " , Seepage Pills, Seepage Trends, Privies. or Portable The operating condition of the septic tank and outlet filter shah be assessed at least outlet filter haft once every 3 years by inon. The s be donned as necessary to ensure MW ppation. The Nor cartridge should not be removed unless W vislens are made to retain solids in the tank then may slough off the tifisr when removed from its arwb t m. if ttne 05/02/01 WED 10:87 FAX 715 386 4666 ST CRX CO ZONING _ Management Plan for a Septic Tank and Soil Absorption Component titter is equipped with an al arm, the filter shall be serviced If the alarm is activated continuously. Intermittent filter aiatms may indicate surge fact or an impending continuous atarm. The septic tank" have its cortlents removed when the volume of scum aunt sludge in the tank exceeds 113 fly liquid volume of the tank, if the contents of the tank are not removed at the time of an assessment, rnwgenanae personnel snail advise the owner of when the next service needs to be performed to maintain less than mwdmum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness aril soundness. Access openings used for semm and assessment shall be seeded watertight upon the completion of service. Any opening deemed unsound. detective, or subject to failure must be replaced. Exposed access openings gfeater than 8.4ncthes in diameter shall be secured by an eifecl;I" lo"g device to prevent accidents! or unauthorized entry into the tank. No one shond enter a 39000 or other fry or hokft tw* far any regon **bout banns frt fist canpltan" vdW OSHA samllords for enfering a comb ad &pence. The afinosphta+s ht Whin the septic or atlHr dint of holding W* my contain $800 ysa$, Md rescue of a parson fhr>Mn floe kow iw of tae shay bs or knposs#jio- Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. §W1 AhlgSftn Component The soil absorption component serving this s#Wure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption corrhponent depends greatly on Proper and Ohl nnaintenance, and system use within or below the i its of reliable operation. Good water oonsarvation practices by all occupants and the installation of water Conserving plumbing fixtures are key factofs in extending the useful We of this component. ponentit. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shell include reCwdng the levels of ponding, if any, in the obsenvaton pipes, and a visual Inspection for any eviderim of surface seepage or discharge from the cmnporw& on steeply sbping sites, era" of erosion should be Won#tied and reported to the owner for repair. The surface discharge of domes"eC wastewater of sewage from the system is prohibited and considered a human health haz&rd. Traffic around or over the soli absorption component should be avoided particularly during whiter months. The compaction or removal of snow Covet over the component may lead to hydrouic failure by fretting. This type of failure is usually tenplyary, but is difficult or Impossible. to repair until weether conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal call, which may lead to more intense, and earlier, organic cknKft of the soil. 2 05/01/01 Wn 10: 29 FAX US 346 4696 ST CRI CO ZONINU • Management Plan for a S"W Tank and SO# AbsOrMiOn Component pW"s of deep-rooted VOW MW shrubs dWOM Over or vgMin ton W of the O wpxwt stoM be avoided *" mot intrusion into the MqMwt n OWW WS***8W fkrw. 6T. caui, ZJIvUva' = 586-4680 plumber = Calvin Powers - 246-5135 Replacement site will be that soil tested area by C,3T (# Replacement site must be left undist;Lrbed, or management/ contingency plan must be modified and filed with the zoning office, outlining the steps to be taken in event of septic system failure. 3 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer � �` � 8 Mailing Address V `75 fy\o h M Q A ti W,-P_ kkc 1 vv\ cO 4n A Property Address i a i (Verification required from Planfltdg Plan ' Department for new construction) } City /State Parcel Identification Number Q� 3S - l l 3 D a LEGAL DESCRIPTION Property Location IV U- / <, 5 UD '/4, Sec. T JN -R_L2LW, Town of S ' Subdivision Cg Vin V o t . i . ct �q -(p Lot # Certified Survey Map # la 3 o S 4/ , Volume _ , Page # Warranty Deed # Log �0 l V , Volume Page # Spec house ❑ yes X no Lot lines identifiable q yes ❑ no SYSTEM MAINTENANCE 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. The property owner agrees to submit to St. Croix 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 is sy tem has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the thre ye e ' ation date. �O / /�/ o SI NA OF APPLICANT DATE OWNER CERTIFICATION I (we) ce that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of tlp+F"erty desc be a ve, by virtue of a warranty deed recorded in Register of Deeds Office. C 1 I 0 / /off-/ y 1 SIGNATURE 6F APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed V 1644PAG 20 STATE BAR OF WISCONSIN FORM 2 - 1999 Es 4 6169 WARRANTY DEED KATHLEEN H. WALSH Document Number REGISTER OF DEEDS 5T. CROIX CO., WI This Deed, made between Russell L. Flandrick, a single person, RECEIVED FOR RECORD 05-22 -2001 11:55 AM WARRANTY DEED Grantor, and Timothy J. Potter and Stephanie S. Potter, husband and EXEMPT 0 wife as survivorship marital property, CERT COPY FEE: COPY FEE: TRANSFER FEE: 102.00 RECORDING FEE: 10.00 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): Part of the Northwest Quarter of the Southwest Quarter (NW 1/4 of SW 1/4) Recording Area of Section Thirty-two (32), Township Thirty -one (31) North, Range Name Eighteen (18) West described as follows Lot 8 o f Certified Survey Map a ft"A y riONAL BANK filed September 27, 2000, in Volume 14, page 3956 as Document No. 109 E 2nd St 630591. PO BOX 89 New Richmond, WI 54017 Part of038- 1132 -10 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: municipal and zoning ordinances, easements and restrictions of record. Dated this \C;9� day of May 2001 ' • }3 SELL L. FLANDRICK AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. ST. CROIX County ) authenticated this day of , Personally came before me this ""Q day of may 2001 the above named Russell L. Flandrick TITLE: MEMBER STATE BAR OF WISCONSIN Public/StatEiio 1fg� (If not, to me known io a the persons) who executed the foregoing instrument and ac ]edged the same. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Judith A. Remington- REMINGTO LAW OFFICES Notary Public, State of Wisconsin P.O. Box 177, New Richmond, WI 5401 My Commission is permanent. not, state expiration a[e: (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. mbmaaon rrotessmnais company, Fond du Lac, wi STATE BAR OF WISCONSIN 800- 655-421 WARRANTY DEED FORM No. 2-1999 _ a o a n FILE �JW n L 0 W '�:> n 2 7 20 Jf. 00 Vwc) U-U .. wnLSH ��a� ce x ,L > A r. Register of Oce s A a W ate; S ►.CroixCo.,WI jw`: w " wWwa� RTIFIED SURVEY MAP ce C> ¢wf-- N-_ o✓ cn LOCATED IN PART OF THE NW1 /4 OF THE SW1 /4, SECTION 32, T31 N, R1 8W, TOWN OF STAR PRAIRIE, ST. CROIX COUNTY, WISCONSIN. OWNER RUSSELL FLANDRICK RR 4 BOX 162 NEW RICHMOND, WI 54017 CURVE DATA NUMBER RADIUS CENTRAL CHORD CHORD ARC TANGENT TANGENT ANGLE BEARING LENGTH LENGTH IN OUT 10 233.00' 17 °57'31" N 10 °23'57.6" E 72.75' 73.05' N19 "22'53 "E N01 °25'02 "E 616' MG (�GJ�ID OI O�U`JI D pdGQ44L G W I �1/4 CORNER � 01 O° SECTION 32 9i �1 ------ - - - - -- o ..II S89 0 35'39 "E 299.30' �S lal �I I �. IOI OI NCO _ or'I C O w (� PI �ZI iA °' N W of LL ���I IDI N I W) III N o c ;1 LOT 8 N �] 27 S69° '2 ' 87,1 20 SO . FT. 7 2.00 ACRES I S89 °28'"E 649.80' 6 01 N I o I I 0OW I Q �I 0 I �( LL � �� N ° Z °g w a I h� N �I �I Cc N IA NN�v U- w m p 0 a d .0 c M X11 p l a U- o °o G' I I N89 0 36'39 " W 329.18' cnw2 @I D I (DzD m C I 33' 33' g 1 I w d04 C -- I 0 SW CORNER �/ @ � 09 p @n 00 cy) co SECTION 32 ---- - - - - -- b C O Z co LEGEND APPROVED j o ST. CROIX COUNTY Planning Zoning and Parks Committee cc Z ALUMINUM COUNTY SECTION CORNER Y MONUMENT FOUND S EP 2 7 2000 m 1" IRON PIPE FOUND o If not recorded within 30 days of 1" X 24" IRON PIPE SET WEIGHING approval dale approval shall be 0 null and void 0 1.13 LBS. PER LINEAR FOOT Lu ' • • • • • • • . 100' ROADWAY SETBACK LINE SCALE IN FEET 1" = 100' (r 0 1 1 /4" IRON REBAR FOUND U) Z 100 0 100 200 _ I Voi.14 Page 3956