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HomeMy WebLinkAbout040-1312-01-000 n y Q a o d Cn :U T N z o A 0 0 0 C 1 Des N C ° v O A A C CD 7 CD Cb A N �< 0Np O H 1 a < p W () 1 c cn v ° ° o O N N O CJ 7 w O* O. 0 7 =y.. > O Q o 0 0 O O n C 'O A� r^ O r• l� 7 y p O O Ol m O CD ct A w G o m' o a CL o Q Z' CD Z o o 0 C1 O C ° ( D C71 Ln c '', Cl) a CL O O O o °.: �• c4 E N N * o Cr CD T t d N O A CD 0 N — w .. CD 0 � D) 3 - o I CD .. � N N D o o I v "w e CD c CD c CD � N a o n _ _ O. A Z (n A W m OD a z 0 3 a $ U) I � N CD A A 'I Q. O v t M O M. O fl 0 z CD O Q° U) N_ < O N Q 4 CD I n e I L71 N � O Q I a CD ° o lv o O „ c, O N a O L yy ti �i Wisconsin Departme�t of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 479453 ,V, 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: Delta Construction I Troy, Town of CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: /Y LJ t� 1 CS T 04.28.19.&3 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic / , I Benchmark W ' e /2(ob +3 I0 •3 16n Dosing Alt. BM Aeration Bldg. Sewer 7 + 9 7• z Holding St/Ht Inlet 1� 'S 9 1 // I TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic / N PV / $ Dt Bottom Dosing t T Header /Man. $ +5 95•$ Aeration Dist. Pipe 5 5 Q 7 + / O Holding Bot. System • 5 11' 7.6 t �[ \\ 1 q.7 Final Grade PUMP /SIPHON INFORMATION �. Manufacturer Demand St Cover P er J Model Numb , TDH Li Friction Loss System He Ft Forcemain Len ia. Dist. to well SOIL ABSORPTION SYSTEM BEDITRENCH Width / Length C3, No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth (46 j DIMENSIONS Te. rte" '�� SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer. /+ INFORMATION CHAMBER OR Type Of System Model 7 �� UNIT Number. Q J; .nJ6+Jri �O DISTRIBUTION SYSTEM / a - !5 I- /$ = Header /Manifold Distribution x Hole Size x Hole Spacing Vent to A' Inta e Pipe(s Lengt Dia L Dia \ Spacing \ ,� 2 SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over ' Depth Over xx Depth of ] 7reded /So !ed xx Mulched Bed/Trench Center /�• �� Bed/Trench Edges \ Topsoil \ Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: ### Edie Court Hudson, WI 54016 (SW 1/4 SW 1/4 4 T28N R1 9W) Cottage Meadows Lot 1 Parcel No: 04.28.19. 1.) Alt BM Description= �', Cv �— C d �ocXL a 2.) Bldg sewer length = /I / n - amount of cover Plan revision Required? Yes )<.o P / 2 Use other side for additional information. V O 5 Date Insepctor ignature Cert. No. SBD -6710 (R.3/97) i safety county AI W. wasbmgton Ave , P:O. Bon 7162 NN (" ,mmsn Permit Nv ( be filled a by co - ) Department of Commerce (60t) 266 -315I q 79-/ Sanitary Permit Applic ' lm acewd wAh Comm 83.21, Wx;- Adm. CW . . A VED may be used for sm;ondwy purposes Pmbvecy law, 5- 04(lxm) Pt led Addnm Cddiffaidu thin mailing address) I, Application Information -Please Print AS Infonmstioa `' { C y� Property owner's Name - CRW,CCIv i Pealed �a (B F / Blodr 8 7��911� Q'IF a� l'� �I •.gyp - Ma i gg Addies Property Location .;z �� w-- ys -Set/-y1 section _ City, State Zip Code PlimeNumber (� ) II. Type of Building (cheek all that apply) Ab 6 n Subdivisiorh Name CSM Numbs W or 2 Family Dwelling- Number of Balrooms �i �� 1-a O PubliclCommd>aal - Desed'be Use ❑ State Owned -Dr =be Use ❑City OVt71aw Eftownship of III. Type of Perot (Chak edy seat boa: en time A. Compldo lim B if apple) A. 04ew system O Replace &YOM O TrunnonotHeldatg Toot Replacemmt Only O Other mom cation to Existing System B. O Permit Reoewah 8'Pcm it Rakion O Change of O PamitTiaader to New j.bt Pmvw s PU"I& mba and DOe lamed Before Expiration Plumber Owner Ys- rv. Type of POWTS S Check all that aplilyl fikNon - Pressmiad Ia- Conned O Mound > - 2a ra ofsoilidile ied O Moaod <yt in- ofs;o& ble soil O AWwade O Simsle Pass Sand Flea ❑ Cwwu rcma w a O P,eau ; eed hi4ro nd O HOWmg Tw* ❑ Pea Fader O AQobic Tretment Unit O ReCIrC111111tIrg sand Filter ❑ gig sy Mode Fber - Chamber O Drip hoe ❑ Gorvd4ess O Omer cybin V. reatmeut Area Iaftrmatien: t — 3 X 1 -- 2t Design Flow(gpd) Design Sod Application Raul) Dispersal Ater Requited ($Q DbVe sal Area Proposed @0 Stem Elevation VI. Tank I,fo (qty in T� Number 1 Prrdsb Sine Seed Faber Plastic Gallas Gallons efUmits Concrete C ustnrcted Glass � Exisfift Taeda TWO w AmvW Tram ihd VII. Respoasibil'tty Statement- b the uoiasigaed. aahmme re+Poad6ility hhaaDatiors of the Fowls shown out the attached phum Plnmbees Name (Print) plas �fl'/IAPRS Number Business Phone Number l D .,® o 1 ,?/S*- y cave Plumber's A (Street, City, Zip OKU) zwp A 0VZ-0- r om t— jlTo— 173 7, VIII. coos rtaneat use OA O cb Sanitary Permit Fee (mdudes Groundwater Da ) O 5mrage Pee) { (� 66 EL Conditions of ApprevaURe=a= fer ppseral H L ,1 , SYSTEM OWNER: t. Septic tbnk, effluent finer and � -- dispersal cell must all be. r i ervices / maintdned as per management plan provided by plumber. 2. AN setback requirements must be maintained �\ �f�F o n ( . e55 no � as per appNcable code / ordinances. J e a d� AM*- Ala+. plus imeeCOMMbeab )��n+�mw�••cinsti..tnn :il somas SBD -6398 (R. 01/03) Fogerty Plumbing #221180 . 28288 McKenzie Rd. Spooner, WI 54801 f (715) 535 -9609 ' &are v t.�y LdT 1 -3 1i iPyc�.A - I�Ty,�ge�r) — �t � L % .�X�ST sTie pG�,zbid L/ d�a I`aa�cLRxr�v W Sl7ly�0� /oO.B ' Q Gs�T� u,,�rtc 7pO,d -AW. 5 Vv Sys *,�: 93.7 Adir caa - Fogerty Plumbing #221180 28283 McKenzie Rd. Spooner, WI 54801 (715) 635 -9609 lot �r�'Igr �.Zs 'NNE i I.STN �Ba ) /IZ y �e o/f CIY�I �� dFZ �p0'.1/l1�X�iV 3'S9N ,AZZAIT -- � 4'A/ a rF H � S sfi�'o� toeo ' Q AFL .4t,> -+ TSB iP cs.Hc�'r� u,,rac �ooa t AI AA ie 1N u,, ,c cc b � y 0 rA cr bid W it � �a - :d►! '+! _ `�`� - t om + Cl 13 i 0 C40 ID OAi td .'f _ • - `'gyp •-- i -•a a s ~ ~� ~• \ ; tJ b o i tr v� o -h 1 Q N O OD N � cm 0 am o� , ,�8"AL nvacn oaf r•o•• ^ - ••-r — a nd hmi� t PO rnc�de. bid n� bnideel to anw►. and l uftn and percent siope. scale or dam• Date Piome print aNkwo - pb�sanal ialb� you p��� neusedtocseoapda�gou�Ao� - 1d� N Properly Clwner 114 S N R E (�(/ # $icek� Stftd. Warne or CSida Pmpaq stme Caft Phones per p t� sir t,BE.c� t3 h -N�c« u��� cfin � oams GPE - '-.. sow rate — p � p Puf�carao - Deaarw Hood Plan '[apPkWft Parent mralerra! General COMMe + /11�G - r� ST - Firrsr and meoorntaenriaft �o,rJUt+t/I goings /bL Gmaod Mob= dow. IL NO&On Tmclus S 'E Gr_ Sz �- �� �#2 m- t some R D� to snow q t in. p 1i 2w D [� P. Gn o as e��� -- GPa» Hod on Depth OoerAwt l� Desaip� Ted 'EW1 "E lla. 9z. C XIL Cdw t Sz. Sh.� A 1 L Z iu Fig 2 ` Z mss _ S 3 • M2 =BogsS30WGLaadTSS <30mOfL - PI � 2 Y Nombe t . Die E+n Address Fogerty Plirm vmg & P*W& Z - rte"- '•r ! f 1 F 28M MdCaNk''Alil. _ ,�, Page �-- .3 property Owner 4N �� Pam ID # _ fi ❑ Boring # ° Bodre rev D to nibfetes — n Sd Rate Ground surfaos Roots 3 eoh.ad•y GPDO �, oo � Teadire 'EM DOrnirharat Rn Gr Sz. Sh. Horizon o� t ah, sz. Cone taotor a Z - El t< �so factor �,_ o. Sol Rate GPDOW 8orn8 * Pit Ground saariaoe elav Teotbase SMjC Me Co Boundary BOOR 'tw1 'Etf#2 tioriaxn Depth Dorno� rat Redox D��h Gr. Sz. SI k M reset Gr Sz Cohh1 Cater Depth b MWM factor Sot Rate Pit SA"" Boundary o f �� Raao� GPDIIf IiedOhc T ar :gw Modwn Depth Don*gw t CkL W Cod. Coin Gr. Sz S6. in Murd " =-8006 < 30 SO -� < 30 mgr- • Et(WeM pl = BOD > 30:5 � '�- � TSS >3t1 _' 150 rovider and employer. If you need assistance to access services or rce is an equal opportunity service p t at 60995 or 1W 608 - 264 - 8777. The Department of Commc lease contact the dcpartmen need material in an alternate format, p �.urota.arooa i Fogerty Plumbing #221180 28283 McKenzie Rd. Spooner, WI 54801 (715) G35 - 9609 X—a a�2 �va url�X�AI s ' = Yo' 4'Al s.6aj 17 fF STtr( . c r B! r �! 3;mko 0 "00.0 " Q "rx u ,,�tc fOO,d t --- 7 - z A1. �- ,U��; •UGC Ib Sc�,E' I Ate' i Al Mr Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 Madison, WI 53707 - 7162 Sanitary Permit Number be filled in by Co.) t� Department of Commerce (608) 266 -3151 S Sani �Y PP Permit A p p lication state Plan I.D. In accord with Comm 83.21, Wis. Adm. Code, P you Pre information vide 0 / tray be used for secondary purposes Privacy Law, s15.04(lXm) O Project Address (if different than mailing address) I. Application Information - Please Print All Informati [� r � t� Property Owner's Na we 1 # Lot / .81eek d� G � S E P 0 2 200 Property Owner's M ailing Address ST. CROIX COUNTY _ PAY Location D k ZONING OFFICE 1A, 14.Section y City, State Zip Code Phone Number ' _ SOS/ p/ - /! 6` � (circle TN; R4E tVrl Gl H. Type of Building (ch k I that apply) '' Pol Subdivision Name CSM Numbe q or 2 Family Dwelling - Num of Bedrooms i ❑ Public/Commercial - Describe Use ❑ State Owned - Describe Use 4 ❑City - ❑Village [[ownship of t , HL Type of Permit: (Check only one on line A. Complete line B if app W111- le) A. & New System ❑ Replacement Sys ❑ Treatment/Holding Tank lacement Only ❑ Other Modification to Existing System —r List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑Permit Revision ❑ Change of 11 rmit Transfer to New Before Expiration lumber IV. Type of POWTS System: (Check all that apply) i O n - Pressurized Lt rou ❑ Mould > 24 in zivp Mound < 24 in. of suitable soil El At-Grade ❑Single Pass Sand Filter Constructed Wedaw El Pressurized rou Peat titer ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter El Recirculating Synthetic Media Filter� Gravel -less Pipe ❑ Other (explain) �s 0'Ly V. Dispersal/Treatment Area Information: S" c S .,no— p Q Design Flow (gpd) Design Soil Application Rate(gpdsf) Required (sf) DispersafA— Proposed (SO Sys levation t ClC(, a VI. Tank Info Capacity in Total Num faeturer - -� Prefab Site Steel Fiber Plastic a Z� Gallons Gallons of is r,�ft Concrete Constructed Glass _ New Existing Tanks Tanks Seoc oP%R .. Aerobic Treatment Unit Dosing Chamber �_ on VII. Responsibility Statement- 1, the assume rdsponsibility r installation of OeWTS shown on the attached plans. Plumber's Na me (Print) Plumbe Si cure 4 -WWRS Iv Number Business Phone Number Fogerty Plumbing .a.� T/S — 3s— 9�0 Plumbe!8 a QgAjtate, Zip C e) -S e Spooner, WI 54801 VIII. se Only pproved ❑Disapproved Sanitary Permit Fee (' ludes Groundwater Date Iss !� g �,Si re ( N ps) Surcharge Fee) (� t� �'1 ❑ Owner Given for Denial �.�C�(J � d Ir ISeptic r,pl_ AnnrovaUReasons for Disppproval ry � 9GrN tank, effluent filter and 1 /J� 4, rsal cell must all be serviced ! maintained as per management plan provided by plumber. (/ 2. Al se ac requiremen s mus a maintaine as per applicable code /ordinances. Attach —Ode plans (to the Cou&y only) for on paper noldfis thaAl/2 x 11 inches in size t #9 21 -180.- 28288 McKenzie Rd. -- }— }-- - {- 4-- ' — __.. - - -- — ( 715)635 -9609 Y j i ?2oN P/ P/PE • . ruN Lor Co/zn >ccS 1 I / N/ JI, 64F _�___ A -1 --#-221 -180 ! 28288 McKenzie Rd. Spooner; W1 -- -, -- -_—,- —I— — — - -- r _(715) 635 -9609 i 5 o Gr �� I % • `o Q 4` [ fi P isj, � � � � "_ its v� -�• �� ;P&G 1 � prPE � \ ^� \ - 0 I i CD co rA Nz O CD CD a n °., a CD \ rt co V p UD A a. cP — co oo c cr 3 it 11 N � � N Wisconsin Department of . N REPORT Page 1 of 3 Division of Safety and Build EC CC w [� I a ith m 85, Wiis. Attach complete site plan paper Vt n 8 11 ' as in size. Plan must Ste• G (�a X include. tit not drnited to: nice! a�b� 11 (BM), direction and Parcel I.D. percent slope, scale or d' orts, rwRh and location nd distance to nearest road. P se III C don by Date Personal irdormation you (Privacy Law. s. 15.04 (1) (m)). f Property Owner Property Location - T o D r> 13 j E Rsr 6 nT Govt. Lot ?1 E 1/4 SW 1/4 S T 2,g N R lei E (or)e rt Owner's Handing Address l.ot # Block # Subd Name or CSfu 1774' U © � State Zip Code Phone Number O City ❑ Village ® Town Nearest Road 1^/ &'+01(0 - rRo y I So`Omer RA ® New Consdvc tim Use: ® Residential / Number of bedrooms 3 - 5 Code derived design flow rate -4- 5 10 1 - ' GPD ❑ Replacemerd ❑ Put>sc or aornmercial - Describe: Parertt material C2Ztt S O Vf OtITW V6H Flood Plain elevation if appdcable R General comments and Area Spot Tested suitable for a conventional inground system (P.O.W.T.S.) # Bo ® Pit Ground surface elev. Iq, Are R Depth to Gmitirg factor ) 93 in. Sod Appkedon Rate Horimn Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff? In. Munson Ou. Sz. Cont. Color Gr. Sz. Sh. - Eff#'i - 002 1 0- 1 2 I CO Y 2 /1- — 1 2� q r mfr C S 3 , 1f (� 2 ) 2 - 24 I U YR 4 1At - 5 i c 1 2 m 5 b)< rv► f i 0 - 'V 2 �� • �} . �, 3 2q. _ 93 ) a YR mot- - 5 0 5 ►� ! - - . - 7 1 F # 0 Boring 0 Pit Ground surface elev. 99.do ft. Depth to rimi ft factor ) 96 in. sod Application Rate Horizon Depth Dominant Color Redox Deso"on Texture Struchre Consistence Boundary Roots GPDJfy In. Munsed OU. Sz. Cont. Color Gr. Sz. Sh. i `M1 •EfM 2 l 0- 10 yp 2 1 2 — je 2m jr 9 S 3 V - $ 2 1 oYR S1 Cl C 5 N m TI a aV -2 b 3 S + 9� 0 �'R 5�`►- - S 0 59 d ! - - - I <A 4 • t fluent #1= BM > W < 220 rrq& and TSS > 150 mg& • Effluent #2 = BOD _< M moll,. and TSS <_ W troll CST Name (Please ft* soma" " CST Number J F rJ n1 ti L_ B iz lc H -r k5 7'7 3 - � 4 Address Date evaluation Conducted Telephone Number 2-$ 12- (U'rp+ AEG SP2W A4A io '7/s• -gg47- For issuance of permits and designing Contact: Ulbricht & Associates Registered private wastewater consultant and piuderS 2812 10th Ave. ORIGINAL Spring Valley, WI 54767 715 - 772 -3442 A LOT .racyowbar Parcel ID �D — f'D Page z of 3r ❑ B=s © Pic Ground suface elev. W ft. Depth to kWMV fetnor 97 in. Sol Application Rate Hodson Depth Dominant Redox Desm"on Texbve Struckm Consistence Boundary. Roots GPOW in. Munsel Qu. Sz Cont. Color Gr. Sz. Sh. l o_lo JOYR I f m fr e s 3v 4 2 to -26 1oYR31y sic./ 2-0 Q w 2 ✓f -1 . �o 3 2(a V 10YA S 0 55 d l - • 1.(0 F Barg # ❑ Bairg ❑ Pit Ground srrtaoe elev. I Depth to lrrov ihctor in. W Appkgon Rate Hortaon Depth Domtnarn Cokx Redact Description Texture Struch" Canslstence Boundary Roots GPM In. Hansel Qu. Sz. Coat Color Gr. - Sh. 'EM F] Barg # ❑ 6MV ❑ Pit GroerM strfaoe eftv. fL Deplr to liruiing Tailor in Sd Application Rate Hodson Deter Dominant Cokx Redox Deso"on. Texture Struckre Consistence Boundary Roofs GPDIE in Mu>sell Qu. Sz. Cont Color Gr. Sz. Sh. 'E l 'Efts ❑ V Grtxrnul s=owe elev. ft Depth to inBrg factor in F Sol Rate Fortson Derplh Dornin" calm Redox Descdplon. Texture Sinch" Consistence Boundary Rots GPM In. MEN" Qu. Sz. Corn. Cow Gr. S¢. Sh. *EM 'EiM2 • E111uern #1 = BOD > 30 = 710 no& and TSS >30 -< 150 r gk ' EAluerut 02 = BM, 130 wG& and TSS < 3D rnV& The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access se mces or need material in an alternate format. please contact the department at 608- 266 -3151 or TTY 60 8-2644777. aauwoceAroo► �3J rJ�" ('o "f'T�t &i M tow Lod" PAri� 3 OF W - . NO RITP AROPFr.> -TY L-iN 2- g ins 1 - 100.0( %/2 -- SE A Sol IF G'�t Rc�uNU 9q. X2.2' IDS EAST PRo rz - 300 > �O3 g2 = g9.Ot7 wE S-r gMZ= 99.08 5' �=1z PROPER a X3 3 = 133 '!o L 1 N E 3 `} q ., Ya " s e-r = p Ro pela rte L tn�E �'RovrJD 99.00 4 too.o� S -C- A L-S 1., : 40' O - aoRIatT B GNc.N MAR A = Go tl -- ro v R, SUvTtf P RaP�r2T� Ltty 6 q4� ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM _._ ... Owner/Buyer Mailing Address Property Address 1 (Verification required from Planning Department for new constructio City /State W-� Parcel Identification Number ova �J LEGAL DESCRIPTION Property Location S2 r /4, y Sec. 5/ , T_ Zf N -RAW, Town of _ Subdivision Lot Pv_?o 79 , Certified Survey Map # Volume — , Page # Warranty Deed # Volume 2 8 Of , Page # Spec house O yes [ no Lot lines identifiable d yes O no SYSTEM MAI 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 licensedpumper verifying that (1) the on -site wastewater disposal system is iri proper operating condition andior (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 da s of the e y r expiration date S GNA O APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner (s) of the r perty desc ' d a ve, by virtue o a warranty deed recorded in Register of Deeds Office. SIGNA OF 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 ruvv I a uvvnrcn FILE INFORMATION --- SYSTEM _ ❑ NA Owner EGTi¢ Septic Tank Capacity d ❑ NA permit # Septic Tank Ma wfacturer Effluent Fiter Momfscturer ,�L ❑ NA DESIGN PARAMETERS p NA Number of Bedrooms � 0 NA Effluent Kilter Model _ _ — /40 NA [pump Tank Capacity g � NA Number of Public Fac�Tity its !h Q Estimated flow (average) Qd' Pump E k Manufacturer NA P+mp wfaca fl13 Design flow (peak). IEstimamd x 1 -5) - pump Model Soil APPlicatwn Rate __ g�a � Standard Influent/Effluent Ouu ty Monthly aver* Pretreatment: : Unit _ 530 mg/L El Sanded Filter 17 Peat Filter - Fats. Oil & Grease (FOG) O Wetland Biochemical Oxygen Demand (BOD 5220 mg/L 0 NA Mechanical Aeration Sd50 mngA_ a Disinfection 0 Other: Total Suspended Solids (T SS) ❑ NA Monthly average Dispersal Cells) pretreated Effluent Quality y M- Groauui ) 13 tn- Ground (pres�urized) Biocheurnicad Oxygen Demand (ROD v Total Suspended Solids I TSS) 530 rn9� ® NA � At -Grade [3 Mound 0 Other. Fecal ColiiforM (gem mean) 51O' 1100nd 11 Drup-line Other. [3 NA Mai imum Effluent Particle Size Y in dm. O NA Odw: ❑ NA Ot 0 NA 0 ❑ NA `Values typical for domestic wastewater and Se ptic tank efflueM MAINTENANCE SCHEDULE She FmgnncV Service Event ❑ momthis) inspect condition of tank(s) At least once every: rE s) (Mllaxirrrnwn 3 years) d NA Where combined s and scum equals (y) of tank volume ❑ NA pump out contents of tanks) p rruoruthls) am S years) El NA inspect dispersal cell(s) At least once every: 3 Y�� f . , D monthial .� NA L, Clean effluent filter �� At West once every: � D rrwnth(s) lam Pump. Pump controls & alum At least once every: 17 year(s) 0 momMsl Q NA Rrals and pre ssure test At least once eve' D earls) ❑ month(3) — a NA At least once every: 0 years) [INA pR111STRUCTIONS an individual carrying or canons: MAINTENANCE tanks and dspersal cons shah be made by l tine o tauner Septage Servicing Operator_ Tank inspections POWYS Main spec Sewer, POWTS hupecto ; PO Master Plumber Master Plumber R of due tank(s) to identify any g or broken hardware. identify any cracks or leaks, inspections must inchude a visual inspection back or p�'ing of effluent on the ground surface• MINIMUM the volume of combined sludge and scar' and to check for any and to check for any pceding The dispersal cell(s) shall be visually inspected to check the effluent in tfie ° ate P requires the of effluent on the ground ce. du d surfa The ponng of effluent on the ground surface may indicate a falling coed+ and immediate notification of the local regulatory authority' When the combined accumulation of sludge and scum in any tank equals one -third d for na a�ana � ch apter NR 113, co of the tank shall be removed by a Septage Servicing Operator and disposed Wisconsin Administrative Code. mechanical or pressurized components. Pretreatment All other services, including but not lWded to the servicing of effluent a POWTS Maintainer. units, and any servicing at intervals of S72 months. shop be performed by of any service event. A service report shall be provided to the local regulatory authority wi"ur 10 days of completion .Affr UP AND OPEPAXM of products or other chemicals For new constnn tien: prior to use of the nWcw d check treatment l Gaep ls) for the presence atio detected have the contents de that may impe the umomnt Press and/or damage the d call(s). If high concentr of the tank(s) removed by a septage servicing operator prior to use - System start up shall not occur when loll conditions ire frazeo at the infiltrative surface. During power outages Pump tanks may fN above rwnTW highwater levels. When power is restored the excess wastewater will be discharged to the dispersal c result au the backup or surface discharge of call(s) in one large dose. overloading the celNs) �. mall S Operator prior to effort. To avoid this situation have the contents of the pump tank removed by Sep�e power to the effluent pump or contact a Plumber or POWTS Maintain rer to assist -m maivally operating die pump controls restore normal levels within the pump tank. Do not drive or park vehicles over taroks 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' f the Reduction or elimination of the following from the wastewater stream may improve the p and Prolong the floss; diapers; disinfectants; fat; t o POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs % d % dental an foundation drain (sump pump) water fruit and vegeta4le peelings; gasofine; 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 and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS f ' and cannot be repaired the following measures have been, or. must be taken, to provide a code replacement em: soil absorption suitable replacement area has been evaluated and' may be utilized for the location of a replacement system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by a will required setbacks from existing and proposed structure, lot fines and wells. Failure to protect the replacement area result in the need for a new soil and site evaluation to a replacement area. R sys� comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. e rte h t been glad to id a suitable replacement area. Upon failure of the POWTS a soil and site area. If no ')able a holding tank y ion► be to a su rep lac -W y in 11 a a last r es o o replace the led S. Mound and at -grade soil absorption systems may be reconstructteed p the ace following effect at that removal time. the biomat at the infiltrative surface. Reconstructions of such systems must comply «WARNING» ANDIOR INSUF W=NT OXYGEN• — DO NOT SEPTIC. PUMP AND OTHER TREATM TANKS MAY CONTAN LET GASS .DEATH MAY RESULT. IRFSCUE OF A PERSON FROM THE INTERIOR OTHER OF AA TANKBE TANK DWFICULT OR POSSIBLE. #221180 (!io'j Ssa- vw � POWTS INSTALLER POINTS NIAINTAWER i t v EN Name Phone '� /.�" �.3 — 09 SEPTAGE � OPERATOR M Nl�) v _ WCAL ►T Name Name lj 1 C� 1 co —'Ai Phone Phone if - 7ib P This document was drafted in congiliance with chapter Comm 83.22t__(b)(1)(d) &(f1 and 83.54(11, (2) & tai. wa Administrative Code. 0 4 a8Ila 3S_9E3i a k THLEEN H. ' VALSH REGISTER <OF DEEDS a VI ST. CROIX CO a • . a ' RECEIVED FOR RECORD 08/16/2005 02:00PH s., WARRANTY DEED w .. .. .This Deed made between CORNERSTONE Ex�T PARTNERS; `a Minnesota limited liability company REC FEE 11.00 Grantor "and DELTA CONSTRUCTION, INC., a TRANS FEE: 3120.00 COPY FEE: Wisconsin corporation, CC FEE: PAGES: 1 Witnesseth, That the said Grantor conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin: /Yr o - vUO L /0 6 RETURN TO. Y - Lots 1 -13, inclusive, Plat of Cottage Meadows in the Town of Troy, St. Croix County, Wisconsin. This is not homestead property. Tax ID# 040 - 1014 -20 -000; Together with all and singular the hereditaments and 040-1014-50-000 and To g 8u 040- 1015- 80-000. appurtenances thereunto belonging; and Cornerstone Partners, LLC warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and reservations, if any, of record. Dat th day of August , 2005. CO TONE PA NERS, LLC (SEAL) Its: AUTHENTICATION ACKNOWLEDGMENT Signature of as STATE OF WISCONSIN ) of CorRqWffij4artners, ) SS LLC authenticated this day of August�$OA GU (�� i��� COUNTY OF ST. CROIX ) Personally came before me this 15 t lday of August, 2005, the TITLE: MEMBER STATE BAR OF Wjg'* SI f l� f.'. 2 above named t o • ,�!; . * � of Cornerstone Partners, LLC, to me (Signatures may be authenticated or acl�p edged BdiCare G F known to the person who executed the foregoing instrument and necessary) JOU13 acknow d the same. THIS INSTRUMENT DRAFTEW* . • • O �� `^ D. Peter Seguin �i 6 OF 0 1 1% 1 � N I I MUDGE, PORTER, LUNDEEN & SE6ft', 110 Second Street, Post Office Box 469 Notary Public, State ir Wiscopsjn_ 11 -200 5 . My Commission (expires): 1 L Hudson, Wisconsin 54016 w ; IV 00 JJ 9 r w 00 'GO F om nil z N 8103'08' W M V € c t 84.21' 1 ,' , x A OU TLDT 1 t 3765 S.F. co ., CONSUtV EASEMENT C A f V - 2759 PC Va. 2753 M 227 W r R Y i VU. 0 FQ 283 O 1 UNP LANDS o — 04 v w G OUTLOT 2 ( 23686 S.F. o 1 WAY ;.LOCATIONS B.M. TOP OF ' a 0.54 Ac. 3/4" IRON PIN I coNSERVAna+ E�SEYENT W 1 :K EL = 906.14 VOL. 2758 PG sso I I VOL. 2753 PC. 227 VOL. 2347 PG. 283 Lr LENT UNE N 88'33'44" W 287.00' 119.67' Z VA MENT 48.E — 238.90' — r \ 1 I o LOT 1 ?W i N N PIN D I I 43572 S.F. c W I cJ► \ �' \ 1.00 Ac. I I �. p w y W ?IPE -j 04 \ ��\ HWE - 907.03` � c r o � Sao 909.03 w_ _ �a q �) I LOT 2 �� IQ �°�°0 CORNER FOUND AS NOTED ¢ 43667 S F. J 1.00 Ac. � a O. 2 B" IRON PIN WT. 4.173 LBS. /FT. Z I \ N S� 1 ®i / /'�o r) ' IRON PIN \ 2 4 3 S8, �� , ! m _ DUNDS T AT ALL IERS n LOT 3� VATION n N 1 43560 S.F. / /, / ► ,0 0h I 1.00 Ac. / / / o,ti• OPENING M I � t o o L � �� W / 0� w N N �a9 ®\ C3 / a4 o 1ST -%iM 1/4 LINE OF (n E 19 WEST ASSUMED TO Z \ H 9pg,g4 O 0 � I co Q I LOT 4 um 9,OS4� � ° ° I s 1 MXIIMTY OF HIGH WATER — I t OR VNNDOW WELL o 43582 S.F. N / EET ABOVE THE HIGH WATER I I 1.00 Ac. / ry �� � LOT 5 o O I WX - 25' (UNLESS J I N /2 / 43614 S.F. Z I 1.00 Ac. 1 100' DABLE AREA AS DMdD BY I -- — -4 /- - -- -- - -