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HomeMy WebLinkAbout040-1306-03-000 Wiscorlsin 6epartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and, Building Division INSPECTION REPORT sanitary Permit No: 463135 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: Village X Township Parcel Tax No: City Leisure Live LLC Troy Townshi CST BM Elev: Insp, BM Elev: BM Description: � Section/Town /Range/Map No: 1�a Ia-, C , 08.28.19. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ` n J Benchmark 1 j� r j Jeyc) Dosing / `` Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet o' Z- St/Ht Outlet 7 TANK SETBACK INFORMATION �- --�. TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet i Septic � / Dt Bottom S 13 !7 9 L� Dosing j k- i / _ Header /Man. Z Aeration Dist. Pipe Holding Bot. System Z ti Final Grade [ t PUMP /SIPHON INFORMATION r Manufacturer Al i Demand St Cover I c ,�� Uo l G� Model Number 4 I TDH Lift ?� Friction Loss I System Head TD� � Ft Forcemain Lengtf� 1 Dia. q Dist. to W eu tJA SOIL ABSORPTION SYSTEM BED/TRENCH Width Length, No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 1� _ j � \ \\ SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer:, — �t INFORMATION CHAMBER OR y G Type Of System: / / UNIT Model Number. DISTRIBUTION SYSTEM 4- HeaderlManifold Distributi x Hole Size x Hole Spacing Vent to Inta e /, ` Pipe(s) °� \ I �� Len th g � Dia Length Dia Spacing (`<3 SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center ✓ q Bedlrrench Edges \ Topsoil \ Yes No Y� No COMMENTS: (Include code discrepencies, persons present etc.) Inspection #1: / / Inspection #2: Location: 466 Dylan Court Hudson, WI 54016 (SW 1/4 NE 114 8 T28N R1 9W) Sunset View Lot 3 Parcel No: 0828.19. 1.) Alt BM Description 2.) Bldg sewer length - amount of cover = Plan revision Required? Yes No Use other side for additional information. D U b SBD -6710 (R.3197) Date Insepct s Sign a Cert. No. ST CROIX CO UNTY PLANNING & ZONING Tuesday, April 29, 2008 Leisure Live LLC t 466 Dylan Court ,. Hudson, WI 54016 :. CodeAdministm M Regarding septic inspection for Leisure Live LLC. 715 - 386- 4680 € Location of Property in St. Croix County: Land Information & s Planning Municipality: Troy, Town of 715 - 386 -4674 Subdivision or Plat: Sunset View as Real Pr rty Certified Survey Map: 715g..., -4677 Lot: 3 R yclin , Address: 466 Dylan Court 5- 386 -4675 : f4`:. Dear Applicant: A septic inspection of the above reference property was conducted on November 18,2004. This property is located in the SW 1/4 NE 114 of Section 8, T28N R19W, Sunset View (Lot 3 Troy, Town of, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a 4 bedroom home. If you have any questions regarding this, please contact our office at 715.386.4680. Sincer Ryan rrington Zoning Specialist cc: file ST. CRom COUNTY GOVERNMENT CENTER 1 10 1 CARM/CHAEL ROAD, HUDSON, W/ 54016 71 5386-4686 FAX PZC- SA /NT-CRODC. W. US W W VV. CO. SAI NT -C ROIX. WL US �r �, `�. �'� �* � �'�`..,f �t "J a C C O i � r ` S ao . L) tj ID 2,e) 6.,,, lo AWJ =I 4 cr V �v'S (1 vi palV�ld aq Bu121snS pJeAl�I f:WL C6 �:Nl; '+'uR11Smj ■ila��p1t4 W .4w .� w�....:,... RP'�1'� C) '1�`J� � '�`� '4i jaDP(k 'w:x�ltlCUR 'ur.� �(ma 'fiux i xK?�o!�Mry 'uCg00uu0!> l0ni�vR :l1OtUO1 •�n.�AKr� 'oolxeYV ix �ieV w A9RISlfi3i P Si Safety and Coun � 201 W. Washi t .� Y'+ f ftc nsin Ma 'son, 07 - , s Sartita y Permit Number (to be filled in by Co.) - 3151 I/ 3 3 S Department of Commerce TW Sanitary Permit tiQ - ? ! _! State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, p you twov may be used for secondary purposes Privacy Law, s15.04 ZONING OFFI Pro' t Address (if different than mailing address) I. Application Information - Please Print All Information I-AfJ C�T- Property Owner's No me T Parcel # Lot # Biock # ,/_ C� / �� Y;-4> . 4, .. P ., /_ / —_ �r ML 4 ) (Y ) Property Owner's M ailing Address Pro Location �k,Section � 4 C ity, State Zip Code Phone Number i4 �a( circle one) II. Type of Building (check all that ap - T N; R 7 E or W /ae Su.�� 1 or 2 Family Dwelling - Number of Bedrooms _ �< Subdivision Name CSM Number ❑ Public/Commercial -Describe Use .s .�s C7 l/ r °e-u) State Owned - Describe Use - _ -- - ❑City_❑villagexTownship of III. Type of Permit: (Check only one box on line A. Complete line B if applic A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing S stem i � Y P $ la P" Y 8 Y' I r - B. ❑Permit Renewal J Permit Revision El Change of F1 Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. of POWTS System: (Check all that a pply) _ �_ C. kidlS Non - Pressurized 1n- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in, of suitable soil ❑ At- Grade ❑ Single Pass Sand Fitter D Constructed Wetland ❑ Pressurized In Ground `7 Holding Tank Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter Recirculating Synthetic Media Filter Q6,eaching Chamber Drip Line ❑ Gravel -les Pipe ❑ Other (explain) __ r V. Dispersal/Treatment Area Information: — 1(o IM Design Flow (gpd) Design Soil Application Rate(gpdafl Dispersal Area Required (sf) Dispe al a Pr se d (st] System Elevatioc VI. Tank Info Capacity in Total Numtxr Manufacturer ref Site Steel Fiber Plastic Gallons Gallons of Uri 1 A Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VIL Responsibility Statement- I, the u ndersigned, as sume responsibility for io ellatio of t he POWTS shown on the attached plans. T Plumber's Na me (Print) Plumber's Si gnature O MPRS Number Business Phone Number s� I G_4�� Plumber's Addre ss (Street, City, State, Zip Code) VIII. Count !De artment Use Onl Approved 0 Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issui Agent Signature (No Stamps) Surcharge Fee) C3 Owner Given Reason for Denial j 2 IX. Conditions of Approval/Reasons for Disapproval 3� SYSTEM OWNER: _ 4V, 1 Septic tank, effluent filter and ei f dispersal cell must all be sorviced / maintained r as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the county only) for the system on paper riot less than 81/2 x 11 inches in size c+tnr� c�no rD 111 /!1'21 T� ? a�- VN b 3 r t � v I w s �-- et u-dnuvc s Wv V (1 ui paluad auk su+a)sng )oleA!9ul f:000 W! surossny nrleJil8ut W sWewe� �p iu NiAbAlii l'It vaN rSC�jqonp •!np>IOmo H:mjis 7aapd6fegwe4ff 'N�ltlauR 'urd RO.l `t ou>,�ac,�o,�o+W 'ucnoauuor� +anwG :nOluo7 ynolu� �OOiXM u+ >tlewapen AaualS!fiaj a s+ i Wisconsin Departure LIVED SOIL EVALUATION REPORT ,Division of Safety an Buil Page \ of � ` in accords ice with Comm 85, Wis. Adm. Code Attach complete si plan t County IBP ���an 8 /2 x 11 inches in size. Plan must include, but not lim ed to: v 1cal and horizontal re rence point (BM), direction and percent slope, scat or di w, an location and distance to nearest road. Parcel I.D. P ation Revi ed by ''Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). / Property Owner Property Location 2 1 7IE-E V �Z(}p,j h�^JT Sw 1/4 �1 /4.S T N R E( )W l Property Owner's Mailing Address Lot POoclk # Subd. Name or CSM# o- fox 3 3 — SurUsT- Vt�„, �� City State Zip Code Phone Number City .[]Village J�] Town Nearest Road +3RLSR-M lR1 -c_,� �. I s cl DLO c1 l S �c1$S -335 1 T�L.�- — New Construction Use: ® Residential / Number of bedrooms ?= Code derived design flow rate S - ij ob GPD Replacement ❑ Public or commercial - Describe: Parent material e) }4 Y 1 Flood Plain elevation if applicable General comments ft and recommendations: 7_1 w1, C.� w A rJ I ❑ Boring Borin ® pit Ground surface elev. ��� ft. Depth to limiting factor 2 100 in GD Jit6 - - ' V P y Soil Application Rate 6K• Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 o _`Z 10 R 3 L z c., 3 -loo )0�2 y/6 — S (3 0 ,3 m1 - t.Z M Boring # ❑ Boring ® Pit Ground surface elev. L l O ft. Depth to limiting factor 2 C � 9 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz I in. Munsell Qu_ Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 O -1 Z log (R 3 L Z - S l ZFS b k btu' C),ti T - Z`p • S - Z �z .38 tort � 3l6 — Si 1 � m sbk n1 �-1- c� _ . S - �, • a 1oyRVA, 6z o ' 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) Signs a CST Number - •Arthur L ". Wegerer e"�. 03 Z1S " 3 22 TNum Address W e g e r e r S o i l Testing & Design Service Date Evaluation Conducted Telephone Number 421 N. Iiain St. River Falls, HI 54022 12_ ZZ - 715 -425 -0165 Property Owner Et. ` v Nj 7-- Parcel ID # �'1�1 G Page of Boring Boring # ❑ ® Pit Ground surface eiev. L�` • ft. Depth to limiting factor 7 l In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh• "Eff#1 "Eff#2 I o _ � ��� rz...3 � z — s i � Z�s b K wlf� cLv z,� • S • s .� 1O`12 316 _ S11 ZYWfbk h4 `fly ,S - •b 3 4% -)b0 113-t2 yl6 c) 9g WI I .`7 1. Z � F -1 Boring # 1:1 El ❑ 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 /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 •Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /f1 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Effn Effluent #1 = BOD, > 30 < 220 mg /L and TSS >30 < 150 mg /L " Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L Tlie 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) PLOT PLAN Page 3 of Scale 1' =S ' I ON J r `D O. as � 1�1�aJ PsL�sRalll�� C�L.� _ WT � - -_�- r�%�._._S��Z - _DT - CCrZ�tl_Z - -- 715 - 425 - 0165 220 •3 Z1S - CST Signature Date Telephone No CST No • Job NO. 4 Cx +VZNT PIPr 12" t�rN , - � �$' .FROM D{}UR = - . A BOVE G:2ADE b 3"RrSH r R i'3TAltE - now CR WEATHERPROOF JL'NC2"Ios 8;X A PPROVED FINxSHED aRAI�E WITH CONDGZ: `iP.SVN.oi,L" 4" C 7 RISER - •• -.., W/ PADLOCK 6 WARNING S.ABrL i •�4 iii, �' / � i „1 � h WA'iDR TIGHT SEALS GAS I TIGHT ` ;PPROVED ,.,,,., A SEAL PPROVED ) PE 3 1 S �;W�AI,M JOINTS W!TH S IX ro App RO PIPE SOIL R - ` 'ON 3 ` .ONTO PUM F C ' ! SOLID.. SOI MP �. F LLV . ....�....F T . _ I ►' f ; a* RISER EXIT a PERMI C - - ... IF TANK MANUFACTJRER tt E APPR vVED 8£DN JXJER TANK HAS APPROVAL a"PECIFZ • *,C • %aNCRETE PAD CA.,►v45 SEp ?IC �' DOSE TANK MANUFACrORER: ?ER JAY: .ANYC SAS: SErnic f GA tiy� a +ir�wrw� Aid, rQsw Y VLullijr iNC�Dr.vG DOSE Ov GRL FLOWBAH.: i...i 9 ,... GAG. �LAR,u MANUFACTURER mov. MODEL !i1'JM$ER: CAI�AW I?I}rS: A . ZINCHES a G OAL. SWITCH TYPE: ftftft. I' y ►a r 9 s 2 INCHES v MODEL NUMBER, �•• C a INCHES SWITCH TYPE: -� D i.YCNES r „1 'r•QU IRED Da SCHARG£ RAT n v �� , yF'.a PUMP 9 ALARM W RiNG AS . ER ZLZ�R 26.23 +�i'�;� ERI'ICAL DIFf£R tC MINIMUM NETWORXLSUPPL. Z�.:� Gi T AND DISTPTgLj"% aN PIPE , -.�Q ......, �IN XRES SUR E � j � LEFT FEET F ORC , f 3 FT/100 fl F'R: 7, ON FACTOR FEi.T TOTAL DYNA MIC 1 � FLrT "�".'£RNAi: D CF p ^� FE:.. �rh, LM. ..ANN. �rXaiN -, LTG:+ID i �TH�1. ,EVER RGOULDS PUMPS Submersible Effluent Pum EPO4 38 71 EPOS APPLICATIONS • Fully submerged in high ■ EP05 impeller: Thermoplas- ■ Bearings: Upper and lower grade turbine oil for tic enclosed design for heavy duty ball bearing Specifically designed for the lubrication and efficient improved performance. construction. following uses: heat transfer. ■ Casing and Base: Rugged • Effluent systems thermoplastic design provides AGENCY LISTING • Homes Available for automatic and superior strength and corrosion • Farms manual operation. Auto- c2lladiiilstandillasAiSOf78too resistance. • Heavy duty sump matic models include • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end • Dewatering assembled and preset at the for efficient heat transfer, in "F" or "C ".) factory, strength, and durability. SP ECIFICATIONS ■ Motor Cover: Thermoplastic fw Ms Pumps Is ISO root Registered. FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. 1 /0 maximum. ■ EPO4 Impeller: Thermoplas- a Power Cable: Severe duty • Capacities: up to 60 GPM. tic Semi -open design with rated oil and water resistant. • Total heads: up to 31 feet, pump out vanes for mechanical • Discharge sue: 1 NPT. seal protection. • Mechanical seal: carbon- rotary/ceramic - stationary, BUNA -N elastomers. • Temperature: 1041 RK continuous METERS FEET 1401 (60 intermittent. • Fasteners: 300 series 10, - stainless steel. g =--- =- w _. „ mss o 1 _... 30" .,... • Capable of running dry without damage to s _ z.s rr components. 25 ; . _.. a a Motor: • EPO4 Single phase: 0.4 HP, z0 115 or 230 V, 60 Hz, 1550 5 __ RPM, built in overload v*h __.__,_ _._._. automatic reset. a EPOS • EPOS Single phase: 0.5 HP, o _ - 115 V, 60 Hz, 1550 RPM, '' 3 10 _..._. . __... _ . __.;_. .. - � __. __..._... : - -_... _..._ -- -- built in overload with EPO4 automatic reset, z • Power cord: 10 foot 5 standard length, 10 _ SJTOW with three prong grounding plug. Optional 20 0 00._ .. 10 20 _..30......_. 40 50 GPM foot length, 1613 S1TW with three prong grounding plug o z a s s 1 12 msir. (standard on EP05). CA PACITY Goulds Pumps ITT Industries ® 200o Goulds Pumps i Fe qua Effective Feb wary, 2000 83871 II� row -4 Pilick4 STANDARD CHAMBER Quick4 Standard Chamber - - - -- - 48" - -- — (EFFECTIVE LENGTH) f 12" lei ri E B 1- ��. — 34" -- SIDE VIEW SECTION VIEW MuttiPort End Cap -- -- -- 12, ` 6' _ 34" _- —� SIDE VIEW TOP VIEW FRONT VIEW g r ` �� Qatck4��tandar� � ambe yominai�S eclflcatlon$�` � . I�uittP,ort end CaprNomtlnal S ectflcations >�j � '�� `�'����`�; Slze (W x L x H) , r -Y ;: 34" x 52 x 12 Size (W x L x N) ° " x. 3` f... 16":X 12" - Effective Length 48 Invert Height 8" or 1.25" Invert Heigh 8" INFI LTRATOR S iNC. STAN s I IT D WARRANTY !a) The strut3ural,nleprily of each chamber, end pfalo. wedge ar,d otho aCUOSSOry manulaCWR;d !ry InfJbatn i'llnira'I, wtkn 1n5taloo ar 7 operated in a leachlield of an omfie twic; syslalb T. acoordw^ with !nfiltralo rst ❑cfnm warrarttxf to Ind ongn al p nhas. ('Fk ld 'f ngafist dafacNve materiels and workmanship In one year trot, the (late that U1S SC;Jiw` Pell it q �SSrted for the SelN r sy. :.drti cuntarnn'�g It1e Ur rq; provided, tgwavar, That i! a Sept permit 's no; required W aPplieable law the ware rty peeriod will tn,gir upon, the Cale thm ihstallatnx, of the wip (, sy.tern rgn',wo,We.5. Ti) Q".1— its wartanty rigMS. Molnar rtwbl : notify Infiarato in wr trtry at - ;,nrporale H arNprartc - in Gld Saybrook, Connecticut wrtitin Mieen If 5) . , • 'rays of the ae llrgen nerecl. Infifhefex wtid supply rpplacan,GN 1h1AS lur Ur !s deler'ni ,ou _ry InWtrata to be covered by thrs Urtrilw, l Wa.....ly. iniJVaror3 liability spacifn sly axctudas thy coat of ran +ova, argon rns Mali r e.I the Uru Il tiIN= n_ U M TS , l d WARRANT' AND LIEC) WA AS W S T I ESf)F MERC hl ARF LXCLI r. h F. T} a_ IE ARE Nil 0 HER WARRANTIES W,7H RESREGT 5'0 tJhll CLI!G'NG Fa0 IMPLIED WP.RAN71tS f)F MERC:MAN (U1,L TY i -1 put `; 1 e_a3 A PARTICVLAR PURPL,S,L. SYS I ( 11 Is Lr'n"Ied Warranty shall !,,e vtutl it sm' pad of the chamtter syslE"q rani .aclured ! y - .v -rt <ir er than nVAlralor- A,a rmlad Nla; rarely dxs NC rut exlr..nd to he iienlal, consequential, sPaoal cfr indirect darrayes. kd0. ulor shah r"rt ue laue i�x penan,us or ldatec%'darrayes, including loa9 of EnvironrnenUl Onsite Wastewater UutWs ( rrdu[:1101� and PrOMS, tabor and maMnalS, eyerhsad acts. or OIW r lossas Co ra!ponse., iicuned by the Helder rn any third parry. $puCifiUlly er,chtden kutn -'imAred We"" Coverage tire damage to the Units due to wdinary wear and tear, alteration, accident, misuse, abusz or neglect d the Units. thu Units 0@119 subjected to vehicle around covers set fo tralc or othe conrAws which are o )I pemtirtr.7 by the instal :afinn insbudions: failure to inaintai i the 6 Business Park Road • P.O. Box 768 "I'Mr m !!h in the nstatatron instnxtlons, the r iacerran! ni unpnnwr rralg,ia,. info the system clxllairnrg IN Units; faiure of file Units a the septic system dUe to tmprorwr stung ar rnS,roper sizing ercasslva w "v a uyo, irr>4,r "f 91 disposal, a;nVu er operation; or Old Saybrook, Cdr 064 any other event not caused Oft Infiltrate'. This Ctmited Wananiy shad be void !t the Holdu rods to acmpy wnfi all of the terns sal forth fn this Limited Warranty, 860-577-7000 • FAX 860 - 577 -7001 Furtner, it) r� event St III Infllkatsr be responSible fa any loss or damage t 11c Holde file. Units, or any third parry resulting Iron al;lalllNron or at*. 800-221- mart, or irxr any prodmi iability claims of Hoedar or any third party. ro I United N anly to apply, Me Unia muSI be Installed in aocrxdanoe w ith an site . ^ondRiona required by state and kcal roans: all othur aPl`li ble laws. -recd InCd,ratoi `s e1Sta,iaeon ineh uct,cm, ' ldi No raUrssentalnty pl kJWrator Iryf. Ihd ,wlhnrify to change or oxlerxl this uon,or. W'arroniy. No wanalq applies to arty pang other roan the p. .al Moltler The above rGpre$.a5 thB SLindard lkltited Waranty u ='Y Infihra:a A LrnitpJ ry :mler of slale5 and WunliaS rwve difrerent warranty ruyuae nwI5, Airy purchase, Uf Units ShOUld contabt Inliltfatot's Gdtporale Hoadlluaners m 0d Saybrook, rNnr,acticut, pro Ic such purchase to obtain a CoPy of the appliCable wanenly, and Should careNURy read that warranty prior to the purchase of Unite. U.S. Patuttts; 4,759,661; 5,017,041; 5,156,468; 5,336,017; 5,401,116; 5,401,459; 5,511,903; 5,716,163; 5,568,776; 5,839,644 Canad'an Palenls; 1,329,959; 2,004,564 Other patents pending. Ln, "i!iralor, Equalizer and Side Winder are registered trademarks of Infiltrator Systems Inc. I,�10tratol is a registered trademark in Franca. Infiltrator Systems Inc.. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYOTEM SPECIFICATIONS Owner Pemnrt ^ Septic Tank Capacity 6 3 3� Septic Tank Manufacturer p NA D9=N PARAMETERS Effluent Filter Manufacturer z C7 NA Number of Bedrooms 0 NA Effluent Eater Model ,V d NA Number of Public Facility Units O NA Pump Tank Capacity a l Q NA Estimated flow (average) N ds 'Pump Tank Manufacturer i t°si Q NA Design flow (peak), (Estimated x 1.5) Q g al/day Pump Manufacturer E3 NA Soil Application date al /da /ftr Pump Model O NA Standard influanUEffiuent Quality Monthly average` Pretreatment Unit A Fats, Oil & Grease (FOG) 530 mg /L O Sand /Gravel Filter ❑ Peat Fiher Biochemical Oxygen Demand (BOD,) 5220 mg /L 0 NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) Si 50 m g /L O Disinfection 0 Other: Pretreated Effluent Duality Monthly average Dispersal Cells) O NA Biochemical Oxygen Demand (800, 530 mg /L In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) S30 mg/L 0 NA O At - Grade ❑ Mound Fecal Coliform (geometric mean) Al cfu /100ml D Drip-Line ❑ Other: Maximum Effluent Particle Site Ya in dia. 13 NA Other. D NA Ott ❑ NA Other: D NA "Values typical for domestic wastewater and septic tank effluent. Other: 0 NA MAI TBUK11 SCHEDULE Service Event Service Ftegmcy Inspect condition of tank(#) At least once every: a) s (Maxillmm 3 years) Cl NA Pump out contents of tanks) When combined sludge and scum equals one -third (Y of tank volume O NA Inspect dispersal cellis) At least once every: 3 1 h s) (Maxhmy t 3 years) 0 NA Clean effluent fiber At least once every: s) 0 NA Inspect pump, pump controls & alarm At least once every: morithis) ❑ NA CI year(s) Flush laterals and pressure test At least once every: mor>th(s) O NA a earls) other: months) O NA At least ante every: �.r- Other: O NA MANtiMANCE INSTRUCTIONS Inspections of tank& and dispersal cells shelf be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank Inspections must include a visual inspection of the tank( &) to identify any missing or broken hardware, identify any cracks or Isaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cetl(s) shell be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, Including but not limited to the servicing of effluent fliters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Malntaieter. A service report shall be provided to the local regulatory authority within 10 days of compfsticn of any service event. l Page T of START UP AND OPERATION n roducts.or other-chemicals For new construction, prior to use of the POWTS check trastmen I cell(el e e If co ncentrations detected have the contents that may impede the treatment process and/or damage the disp 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 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, overloading the cents) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septsge 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. the Reduction or elimination of the following from the wastewater stream may improve the performance and Prolong etantsf f at POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; dagreases: dental floss; diapers, foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meet scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons and water softener brine ABANDONMENT When the POWTS fall andoned in com wit chapter Comm 83-33, VNlsconsin Administrative insure st alive Codeinsure that the system is property and safely ab • 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 falls and cannot be repaired the following measures have been, or • must be taken, to provide a code compliant replacement system: YC A suitable replacement area has been eval uated f the location compaction an i n s hould be infringed upon by system. The replacement area should be p f om disturbance as Witt required setbacks from existing and pe l establish a suitablelseplaaclement area - Replacement systems must result In the need for a new soli and s it e evaluation to comply with the rules in effect at that time. C3 A suitable replacement area Is not a a vail a bl e aa la t resort to setback an d he fai POWTS s. Barring advances In POW TS technology a holding tank may site ❑ T tank A AII e Willi reconstructed in place Mound and at -grade soil absorption systems may be 'Qg f o� il effectt at hat t of the biomat at the Q infiltrative surface. Reconstructions of such systems must comply with the < < WARNING > > R 114 FI IENT SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY UN ANY LETHAL C L GASSES AND! OF-ATM MAY RESULTYGRESCUE OF N O T E A SEPTIC, PUMP OR OTHER TREATMENT PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE- ADD NAL COMMENTS POWTS INSTALLER POWTS MAINTAINER P N ame u o � .�'� � 1 ar � �f ° Q_ � _� Name a r •.. Phone 7 ? Phone SEPTAGE SERVICING OPERATOR (PUMPER) oC8& REGULATORY AUTHORITY Nam Name eb , Phone Phone f . 3 •Ter Ab This document was drafted in compliance with chapter Comm 83.22(21(b &(f1 and 83.5401, (21 & (31, Wisconsin Administrative Code FROM :SCHJMHKER PLUMBING FRX NO. :7153863121 Oct. 36 2004 04 :44FM P1 - ST CROIX COUM Y SEPTIC TANK. MAIN ENANCE AGRBEMENT AND OWMRSHM CERTIMCATION FORM Owner/Buyer '� e s �,� r V L L _ Mailing Address P a ® t Z O� � 1^ Ol)�— 42_ VeLv j _• c) _ 3 Property Adtiresc ,L a 3 k � (aerificsUou ragWmd froth Placating Deparpncnt for now ceetsttvction) A 0 L 540 � City) Late 7Vr © 'To + ^S """ � �— Parcel Identification Number 0 H 4--14 Property LocAtion Y<, , V:, Sec.. T N- R Town of _ Tr ©..:�j_ Subdivision S t? `X e Lit # 3 Cardfled Survey Map # �_. �' Volume . Page # — WUMUty Deed # Volume ? page . # ML Spoa how Oyes 0 no Lot lines identifiable K yes 0 no - IV �A 5uL "VN a-V\,Cl : S Vt.ow to e.i vto m s \- a,k- e c� Im —11 er vise and amiutanance of your septic systeaa coutd result in its premature failure to inutile wastes. Proper uaslateuame consists of Pumping out the septic tank every @tree years or sooner, if needed by a licensed pumper. What you put into the system can afect die function of the septic tank as a treatment stage in the waste disposal tystta 'Me Property owner agretsa to attb= W St. Croix Zoning Depatttneat a etRifteatioa farm, signed by the ow= and by a = Plumber, teestrieted plumber or a limed pumper verttj * cheat (1) the on• site wastewatecdisposat system is in proper operating condition anWor (2) ai ker inspection and pumping (if necessary), the saptl a tank is lest than 1/3 Bell of sludge. Uwe. tlta =doratgaad have read the above rVquirrtnettU sad agree to tnrlutain the private sowago 4f pow ayttem with the standards set foe* hcrcin, as set by the Department of Commerce and the Department of Natural Resources, State of Wisaonsiti. Certification t:tstlttg that your septic system leas been watnWmd runt be completed anal rotamed to the St Croix County Zoning OPlice within 30 days of the duce year expiration date. // L LO y x.-iZe 210NAnW O PUCAM DATS — OMMR CERTIFICA= I (we) certify that all statatments on thus forth we true to the best of my (our) lmowledge, I (we) am (are) tlbe ownet(s) of the property describod above, by virtue of a warranty deod tvoordod in Register of Deeds Office. stcA+tw�txa oa 1CANT D ATE w••s "• qt information that is in tho ssaitary permit being mvokt d by the Zoning Department rs "" • •• faclude with this applieance: a "n"d warranty deed fi= dw Register of Deeds office a Dopy of rite earthed suave y maP It rcfutraflo is rands hz the wamerty flood Q a II� STATE BAR OF UCUIN EORIv1 7- 1998 KATHLEEN H. 1iALSH WARRANTY DEED REGISTER of DEEDS ST. CROIX CO.. WI Document Number RECEIVED FOR RECORD This Deed, made between B & L Land D Inc 10/06/2004 03:15Ptt a Wisconsin Corporation, — ___........ WARRANTY DEED --- ._ - ..... - . _ EXERT # _ ..... _—,.__ — _........._ _ �- -- —. Grantor. REC FEE: 11.00 and — Leisu L iv e, LLC, _ -__- - -- TRANS FEE: 269.70 COPY FEE: CC FEE: - - - -- - -- — - Grantee. PAGES : 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in _ St. Cro ix _ - - - - -_ County, State of Wisconsin: Name and Return Address Atrref iCAn i 5e-rV -e �QX �15b w= 5go)6 0 l0 - 10 0 -1 0 — \0 3°� ~Ucx� ODD \o3� - ZuC> - % OO ,oVO lci - 7 - Z> Parcel Identification Number (PIN) This i-s riot homestead property. (is) (is not) Lot 3, lat of S unset View opment, Town of Troy, St. Croix County, Wisconsin. Exceptions to warranties: Subject to easements, reservations and restrictions of record. Dated this `"day of September 2004 B & L LAND DEVELOPMENT, -INC. , a WI Corp. (SEAL) by - • ? (SEAL) — Secretary- Treasurer ( SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin. ss. St Croix County . authenticated this day of Personally came before me this � ay of SeD'tember - Q the above named Barbara A Gei sR i ngerr as 4e, ref - a ry_ Treasure of B & L Land Dever oo=ent _ Inc a Wisconsin C_orporati can F TITLE: MEMBER STATE BAR OF WISCONSIN — — — — — .... - tO (If not. me known to be the erson -__ who executed the foregoing - authorized by §706.06. Wis. Stars.) instrume nd ledge the same. Roger D. Bevers THIS INSTRUMENT WAS DRAFTED BY Notary Public - -� Stephen J. Du nlap St ate of Wisconsin- Notary Public. State of Wisconsin Hudson, Wisconsin — M mmissio �pe marlehI (If not, state expiration date (Signatures may be authenticated or acknowledged. Both are not L / / y e2j necessary.) Names of persons signing in any capacity must be typed or printed below their signatunt. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., )nc. WARRANTY DEED FORM No. 2 - 1999 Mdwaukae Wis. N th ° ' p, , � 6 LOT 1 CSM VOL. 5 PAG < al 0 ` 22522 S.F. o \� .7 0& 0.52 Ac. A f �Q� 0 1 IS FOR THE PUf LOT a ' r s * PROPERTY ` OWNERS TO AW rn 48334 S.F. LOT 4 � 4 pX 1.11 Ac. S s ?• m ! �� ? 44555 S.F� �. QrF 700, 1.02 Ac o CDC N LOT 6 s4�4 ss o / p 44256 S.F. o S O ` 1.02 Ac. o 6 90 9 ,) 0 v� ' 0 1 24S 26 Me / / � 0 - p�96 2� a z 0 r^ ® o < $I ILOT� 0 100 OD r r i 0 �'' 5 6 /'� rw • I43961 S. �� . LOT 7 0 o ! C. A 7 10 .cam /� 44380 S.F. .J ` I Ln �� L _ .J �' „�o I 1.02 AG, S 7 . rte,, O! N 86'22'22 "E 254.35 � g 9 , g2� 6 0 , ) ( ° (Al yl o Z LOT ©= 2��,� LOT 9 co 143567 S.I. �` 44362 S.F. Q 1 cn . cn 00 LOT 81 A c. 5 U , 1.00 Ac. L 3 30 "E 290 .g 2' 'L 1. 0 1 c `- -- --- I g N 165 '(, it �. o a �� ® o < N 52' 13' 11 "E `J95.86' ......... . < I , w N I LOT i o �,� 46.1 s' r I 82522 S.F. �, � v as a v 100' �! 1.89 Ac. o -n I J^, c' �. ... ., o ! 33 , ' HWE ; �s�� 32.48' Ln TRIANGLE ��� 4 h�� TRIANGLE _ N 3 33 BR ICK _ �._. --'/ / !� M CIRCLE JORDYI+ — LANE 34 LOT 36 "' ' L( ._L_ 5 ,42' 282.59 @ I 58 • . Q; 52620 S.F. i Z REC. AS 33 ( S 89'x3 35"W 333.01 r i'� w s. �� 1.21 Ac. ( 1 � � I 3.2 B M TOP OF t � � IP 908.03' top 4 . v m 47246 S.F. �, Le (�! i CSM VOL. 17, PG. 4526 z Oov 1.08 Ac. o r I LOT 1 -. o - -- —�� f + L I Z 'z m N �J ` 295.65' — 91.15' . ( N ar4( i U N P LATTEC UMM EASMAZM NO POLE OR BURIED CABLES ARE TO BE PLACED SI INSTALLATION WOULD DISTURB ANY SURVEY STAKE, C SOUTH 114 CORNER, ALONG ANY LOT LINE OR STREET LINE. SECTION 8, FOUND THE DISTURBANCE OF A SURVEY STAKE BY ANYONE ST. CROIX COUNTY SECTION 236.32 OF THE WISCONSIN STATUTES. UTILII ALUMINUM MONUMENT HERE IN SET FORTH ARE FOR THE USE OF PUBLIC UTILITIES HAVING THE RIGHT TO SERVE THE AREA. NOTE: THE PARCELS SHOWN ON THIS MAP ARE SUBJ COUNTY AND TOWN LAWS, RULES AND REGULATIONS MINIMUM LOT SIZE, ACCESS TO PARCEL, ETC.). BEFO DEVELOPING ANY PARCEL, CONTACT THE ST.CROIX CC OFFICE AND THE TOWN OF TROY FOR ADVICE. THIS PLAT IS LOCATED IN AN AGRICULTURAL AREA. H EXPECT TYPICAL FARM RELATED ACTIVITIES THAT INCLI 100 0 100 200 300 NOISE, EXTENDED HOURS OF OPERATION, ETC. GRADING THAT WOULD ALTER THE CAPACITY OF THE S GRAPHIC SCALE - FEET IS PROHIBITED.