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HomeMy WebLinkAbout040-1306-22-000 r ,sconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St IX afety and Building Division INSPECTION REPORT Sanitary Permit No: ' 499256 0 'GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Cox, Mike I Troy, Town of 040 - 1306 -22 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No'. 6 C TT /Z2,t, �� 6 enl_ 08.28.19.1849 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic' / / 2 / Benchmark �v �2 D Dosing Alt. BM (rU Aeration Bldg. S wer f r - -- f7 Holding SUHt Inlet St/Ht Outlet J TANK SETBACK INFORMATION -�-- 5 TANK TO P/L .- WELL LDG. Vent to Air Intake ROAD Dt Inlet Septic r �-,yp Dt Bottom -� �--- -- Dosing _ Header /Man. Aeration = Dist. Pipe a Holding e , System `. Final Grad' Gtr, PUMP /SIPHON INFORMATION /A ( . `j Yom` � / /d - 0 Manufacture Demand St Cover r GPM r) % Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain LDia. Dist. to Wei SOIL ABSORPTION SYSTEM BED /TRENCH Width Len g f No. Of Trenches PIT DIMENSIONS No Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer;- INFORMATION CHAMBER O if'Yr/) Type 91 System: f U Model Number: DISTRIBUTION SYSTEM Q�L.r� P✓t� HeaderlManifold Distribution x Hole Size x Hole Spacing V Air Intake / y Pipe(s) Length Dia_ Length Dia L ° Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center J Bed /Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: _t� Inspection #2: Location: 441 Jordyn La Hudson, WI 54016 (SE 1/4 NE 1/4 8 T�288JN R19W) Sunset View Lot 22 Parcel No: 08.28.19.1849 1.) Alt BM Description 2.) Bldg sewer length - amount of cover = Plan revision Required? Yes Use other side for additional information. A Date Insepctor's Sign ture Cert. No. BD -6710 (R.3/97) Safety and Suildli g Division County 201 W. Washington Ave., P.O. Box 7162 Madis 0 I Vis on, WI 53707 7162 Permit Number (toe to n by Co.) Department of Commerce O 266 - Sanitary Permit Application see Pan I N �/A In accord with Comm 8321, Wis. A lm. Code, personal 6dbrtmtion you provide maybe treed for secondary purposes Privacy Law, AS. I in Project Address (if different then trailing addront) 1. Application Information - Please Print All Information 1 y Property Owner's N me DEC 13 2006 Parcel A -+� `• . Bbek A M C b °ter Prope Owner's Mailing Address r ST. CROIX COUNT Property Location Ozl,0 -1366 0 oo1W F- 1/4,1& �,4, Section City, State Zip Code Phone Number T i N: R "E or W 11. Type of Building (check all that apply) GA a2 Family Dwelling - Number ofBedrooms SubdivisionN CSMNumba 11 Publicl�Commacial- Describe Use St~>vj{ ❑ State Owned - Describe Use ❑City ❑Village gTownship of b Ill. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ' [flew System ❑ R ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System • B. ❑ Permh Renewril omit Revision ❑ Change of ❑ Permit Transfer to New Last Previous Permit Numbs and Date bbnred Before Expiratili n Plumber Owner IV. Type of POVPTS Syrtem Check all that appl ONon - Pressurized iti4koond ❑ Momd > 24 . of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At - Orsde ❑ Single Pass Said Filter ❑ Constructed Wetland ❑ Pressurised ❑ Holding Tank ❑ Pat Filter ❑ Aerobic Trestruerr Unit ❑ Recirculating Sand Faker ❑ Rm*cwating synthetic Media Filter Chamba 0DnvLinc ❑ Gnveb Pi ❑ Odra ' ) V.Distsusalfrrea tmentAreaIutormador. Design F low 40) Design Soil Application Rate(gpdaf) Dispersal Area uired q Dispersal Area (s() S Q Elevation VV a o 1)r VI. Tank Info Capacity in Told Number Manufaaura Prefab Site Steel Fiber Plastic Gallons Gallons of ualts Concrete Constructed Glass New ExMina Teaks Tanks ScRi Aeolic Traunant Unk ll, Donlan Clarmbe T � VII. Responsi Statement- 1, the ■ aaapw fewspeadMity for h tailadao of the POWTS she" as ttre attached Phnnber's Name (Print) PI MP/MPRS Number B Dbtiu -�Da9a Plumber's Address (Street, City, State, Zip Cod V7 b DW k M �\A pstw Vill. a /De artmert Use 0A1 Approved ❑Disapproved Permit Fee (includes Groundwater Date ued ssumg ` ) Sari lruga Fee) D 1 Z ❑ Owner Giver Reason for De nial � 3 � IX. Conditions of ApprovaUReaaoas for Disapproval SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell Must be serviced /maintained as per management plan provided by plumber. .eU / / b 2. All setback requirements must be maintained as per applicable code/ordinan Attach eomsplek plea; (ter IY County a*) for do systems oa POW W11010 ttraa $14 It i I iacha is das SBD -6398 (R. 01/03) o A4me ryvll� crix Tm 'Bo amees+er L omi ion S\4 � �► G�Ge�se o a!�dq � 13 TSO Cr 3 IDWJ T , �kl T RD L as s o 00 o m A4 me . C ox S t - - o o\ mee s � C UGCI.� %OIL S� U U � �► G, G e use o Pit \ 3x ���� B3 p � � I �S (jU i Ia�� y,l well T N � uc�As Lot as i so i' 2057 Wisconsin Department of Commerce SOIL EVALUATION ART Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations County 7 Attach complete site plan on paper not less than 8 %x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or danerraions, north arrow, and location and distance to nearest road. Parcel I.D. 040- 1306 -22 -000 Please print all information. Reviewed By Date Personal information you provide may used ITEto"b I s. 15.04 (1) (m)). Property Owner Property Location Mike Cox Govt Lot SE 1/4 NE 1/4 S 8 T 28 N R 19 W Property Owner's Mailing Address LUUU Lot # Block # Subd. Name or CSM# 80 Meadow Lake Drive I 22 Plat Of Sunset View City Stat Zip Code Phone Number J City J Village a Town Nearest Road Hudson I WI Troy 1 441 Jordan Lane New Construction Use: W1 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD J Replacement I Public or commercial - Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Site suitable for conventional dispersal cell at 0.7 gpd loading rate. System elev. = 92.50'. [i] Boring # J Boring J Pit Ground Surface elev. 97.65 ft. Depth to limiting factor 109" in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 " ff#2 1 0 -17 1Oyr2/1 none sit 2fsbk mvfr cs 2f 0.6 0.8 2 17 -31 1Oyr4/3 none sit 2fsbk mfvr cw 1vf,f 0.6 0.8 3 31-46 10yr5/6 none Is Osg ml gw - 0.7 1.6 4 46 -109 1Oyr6/6 none s 0 sg dl - - 0.7 1.6 [ ] Boring # - I Boring e Pit Ground Surface elev. 97.92 ft. Depth to limiting factor >1 13 in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *E 1 P *Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-16 1Oyr2/1 none sii 2fsbk mvfr cs 2f 0.6 0.8 2 16 -28 10yr4/3 none sit 2fsbk mfvr cw 1vf,f 0.6 0.8 3 28-42 1Oyr5/6 none Is Osg ml gw - 0.7 1.6 4 42 -113 1Oyr6/6 none s 0 sg dl - - 0.7 1.6 * Effluent #1 = BOD 30 < 220 mg /L nd TSS >30 < 1 mg/L "Effluent #2 = BOD S30 mg/L and TSS <30 mg/L CST Name (Please Print) Signet CST Number James K. Thompson 5 - - - 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, W154020 12/13/2006 715 - 248 -7767 Property Owner Mike Cox Parcel ID # 040-1306 -22 -000 Page 2 of 3 3] j Pit Boring # rin Ground Surface elev. 97.75 ft. Depth to limiting factor >112" in. Soy Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh: •Eff#1 'Eff#2 1 0-30 10yr2/1 none sil 2fsbk mvfr cs 2f 0.6 0.8 2 30 -52 1Oyr4/3 none SO 2fsbk mfvr Cw 1vf,f 0.6 0.8 3 52 -68 10yr5/6 none Is Osg ml gw - 0.7 1.6 4 68 -112 10yr6/6 none s 0 sg dl - - 0.7 1.6 F-1 Boring # J Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff*1 •Eff#2 I i F-1 Boring # Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture SMxAure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Ef1#1 'Eff*2 " Effluent #1 = BOD 30 < 220 mgA- and TSS >30 < 150 mg /L • Effluent #2 = BOD <30 mg/L and TSS S_30 mg& 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 (it07/00) A.C.E. Sctl & Me Evsk ab" �- Z O r Elegy' : A9.z8. EA 3.6 �-rade • G /✓roP S� . U dZ 5 • ,/ �e�� #29 0,7 .ZZ, A e o {� � ✓�o aP/��ec;c�rle S(u�e Sc•.�,Sc� d�e�o, SE!'yhEyy Seed, T-��, 63 • ■ ar Pro posao� r�(bcdr�m Rc.s,�na 0 - 22 ig p r� 3 W3 Safety and Buildings Division County j 201 W. Washington Ave.. P.O. Box 7162 VIsconsin Madison, WI 33707 - 7162 Sanitary Permit Number (to be filled In by Co.) Department of Commerce (609) 266 - 3131 // ? � ZS State Plan I.D. Sanitary Permit Application Number In mm accord with Co 83.2 1. Wb Code, personal intbrmation /V/ may be used for in Project l A � dd ' re ` ss (if different than railing address) I. Application information - P Pri t All Information �-- Property Owner's Name 6 Parcel N Block o ,i 5�- L ST Property Owner's Mailing Add Property location /) ma y } CJ �. /�, A' /A, section rJ City, State Zip Code P hone Number IL Type of BaiMin` (check all that apply) a k Subdivision Name CSM Number 1 1 or 2 Family Dwelling - Number of Bedrooms `vyb rn,' a e fed JS2 Pubiir/Comrnerciai - Describe Use /n� Pl Q-^- O Saft Owned - Describe Ilse Z U; - t& Ce 5 r-- j y t I C ti e OC ity_❑V"lage luT ownahip of 111. Type of Permit: (Check only one box on line A. Complete line B if applkable) b 0 (o • A' V New System ❑ Replacement S ❑ TrestmrntlHolding Tank Replacement Only ❑ Other Modincati isting ZS •B. C1 Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New list Prev it Number and Before Expirst6n tuber Owner �P y 1 IV. Type of POWTS S Check all that apply) er r ffi, !n-Pressurized in- Ground ❑ Mound > 24 in. of suitable soil Mound <'24 M. o ble soil ❑ At4kWe ❑ Single Pass Said Filter ❑ Cquhucted Wetland ❑ Pressurized In -Ground ❑ Holding Tank t Fil Aerobic Treatment Unit ❑Recirculating Sand Filter ❑ Recirculating Media Filter ❑ Leeching Chamber ❑ Drip ' Gnvel-leas Pipe ❑ Other ) V. Disoorsalffreat meat Area Information: Des Flow (gpd) Design Soil Appl Rde(gpdsf) 1 Area R (SO Dispersal Area Proposed 1) System Elevation / �0 a 85 s� �ma ✓ VI. Tank Info Capacity in T Number Manuf rer Prefab Site Steel Fiber Plastic Gallons s or Units /I Concrete Constructed Glass New Fada h/ Z c V�Q Tanks T 1 Sepia M Holding Tank y Aerobe Tran— Unit Daring CU b. VII. Rap Statement 14 the • ass som, Miily for Installation of the POWYS shows oo the attarbed Phsnbees Name (Print) PI eg SWOM MP/MPRS Number Business Plumber's Address (Street, City, State, Zip VIII Coaat /De partmesill Use Onl t(A pprovix! ❑ D, Sanitary roved Permit Fee (includes Groundwater Date Issuing Sumlwrge Fee) ' j - ,w ❑ Reason W �j IX. Conditions of Approval/Ressons for Disapproval SYSTEM OWNER 1. Septic tank, effluent flfter and dispersal cell must all be services / maintained as per management plan provided by plumber. 2. AD setback requirements must be maintained as per apps code / ordinances. Atdrch tampkte plam (N the CaaNy only) for Hw syskm w paper sot kw don 2112 s 1 i lulm IN an SBD -6398 (R. 01/03) t Tin l:�ou �e mees � G, Geese �!�dQo � M and I�i R' ( i 5� t e �G el 4 �'r � Q eUxvbir��, B IN k 4 CO , f ! Y �. t f � g < `i t o ap A4M6 (�c A riofv\ 7 R*ameesier 8ehc,1, � M t ICK 1. (lr2RO Pry Lvt�1vP 3k °t.�U 1`I C.I.eM� R' l r l r �} Reoxo1, GW�1) t i \ 3 y 1 t j t � \ I Wisconsin Departmen of Co f J\jF -� SOIL EVALUATION REPORT Division of Safety and uildings Page o f o cL i9 *danc with Comm 85, Wis. Adm. Code ` Attach complete site lain on�bper not less th 8 1/2 11 inch ZRe�,�ieed include, but not fimite to: ve es in size. Plan must j <1fa_ refer ce point (BM), direction and percent slope, scale o dimer� � tion and distance to nearest road. ease print all informatlon. ''Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner u 246 - Property Location h' L SE 1/4.M1~ - 1/4.S T Z� N R �� E( W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# Z3 Box 3 3 Z — ISUrQZ City State Zip Code Phone Number V l) El City ❑ Village Town Nearest Road +3 R r�l �Rk.� 1." 1 5 �l 8`l O (1 I S � qgS _ 33 5 I New Construction Use: ® Residential / Number of bedrooms - �4 Code derived design flow rate q S Q - ❑ Replacement ❑ Public or commercial - Describe: 00 GPD Parent material G L_J�C) L Flood Plain elevation if applicable General comments and recommendations: V8 Boring # Boring I F� ZdD E ® Pit Ground surface elev. 0 1 ? ft, Depth to limiting factor 7 b in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence — Boundary $*E IA ication Rate in. Munsell PD /ftz Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#2 r e� -� �.� S -3 -g b 10� � /( �8 •� Z 1 t� a Boring # ❑ Boring ® Pit Ground surface elev. C ) -) Q - S ft. Depth to limiting facto in. Horizon D epth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil A GPD /ft2 Rate in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1b`1,R 3 L Z _ � 'Eff#1 'Eff#2 s I I - Z S b! vv W cw z , 5 -8 t2 �p Z0�2 3l6 — sl I �� sb 3 m Z _ rl e cv 5 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 m CST Name (Please Print) — s _ g/L and TSS < 30 mg/L . Si ,afore CST Number Arthur L tdegerer �. O3 Z S — a 220254 Address W e g e r e r S o i l Testing & Design Service Date Evaluation Conducted 421 I1. Ila i n S t. Ri v e r F a 11 s, [7I 54022 � Z —1 71 Telephone Number �1 - 0 3 5 -425 -0165 Property Owne Et (7 NI 7— Parcel ID # G Page Z ' of Boring # ❑Boring n �? ® Pit Ground surface eiev. `�) 9 C __, ft. Depth to limiting factor --;, C) 3 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. • Eff#1 • Eff#2 s 1 S k Yv1�1� cct,j Z`F • S -� .le s 12 >,1 �r c9 - • s O S Cj Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •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 /ft In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 - Effluent #1 = BOD, > 30 < 220 mg /L and TSS >30 < 150 mg /L • Effluent #2 = BOD < 30 mg /L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608 - 264 - 8777. SOD -8330 (R.6/00) Property Owne `- ��NJf� 7— Parcel lD # ��'�JN7.�) ) n/ G Page ; of a Boring # ❑ Boring ® pit Ground surface elev. q9 - - L ft. Depth to limiting factor 7 3 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fl In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Z �b�23) — S1 Z sb 1v1�1� C--5 Z`F •S -� z �Z. 30 1 O`'l 2 3 � (, — � S j 1 Z bv1 g (2 �'1 �� � _ • S _ 8 Z Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in, Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft= in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L • Effluent #2 = BOD < 30 mg /L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 -266 -3151 or M 608 - 2648777. SUD -8370 (R.6/00) PLOT PLAN Page ' of = Scale 1' =50 100' �C'1C� S i \ 7 '� Z I Rq- 7 yS' I L=L. J O O. 0 0 \ \ " -t ml - 11Z_O)Q A l PC Lo C.UYL.Aje , Ty�tL�3lc� "i�t_ PVC PIPE wl Lam. 715- 425 -0165 220254 Z)S Z CST Signature Date Telephone , -To. CST No. Job NO. i ' _ �o � .tee. �• _ _ °RAAF Rp� w R« 4R "J B ?V k Ell" w ;Ay r p„ Ra &Fp " .kb L rRA'. i «: eRCEir C B�:�• i Q �/� b—' a; e} s�a> x�^ pC7q «>"cq:, ^= ;'gbSk�krR$xgxba�a y W i F 5 - ` . -a ss - !� k axkR - kk` x7R}� xkYa >b � — L a � •! ,4 r 7 oii a S'q R7fR °:: 'k:J' ;h3R7� =Y �'s R i ' ^_ a sa8g' ReaBea9BBSBBRRR .sRaB9.BSa §sk6 "sa9ksa'sa :,"_" asaasxessc : „ „ "aa��c_aac „ „azaa�acga THE ORCHARD v SUBDMVI IUN &I I ( LOT 5 / LOT 4 ' °” \ LOT 3 \\ LOT 2 / / r $ »YI I / us, ... ,. ,«<xE �i• 5O WOVE 1313.16.175,.,5' \ c S !j0'0.1t 7 3l6.37'vs wa onwo� T.ar •RS.t ; i. •4,.6 � . , .. T260.61' o =. i ii o ad�4 18 I F I I �I i t R 1 00001 T . $ O \ \j.[B'0t1 @. J !`� .1C'LCI •/ � 5M1 \\ f� � IR + l __ —o? a. � i g � o � S_ Ir ° w n I .11 ell Z , / $ 4 �� O � g w '' N O •T 16 7),7 I _ O I \ 5 1',e 36 - E �`• T'). \m \ O � \° \ N I - I � m j s0 'o' j =`,� : ' k ' . ! V pO 5 y c �jzJ.P c• 5 � � � '� �, - I � � - I,N x lNi p s., ;ilx __ - � - � - � �- - y � 9p "< „ ic` \\ - M N \ • \\ - - In 8 h a � I i F�el i .r.,,+ ©� .�n) � o o � $ $\\ ��z.eb• T.•.ee' So.7, ” I I Y u L - - - --- - -J L--------- 1 .2- •ee.•0' ° I - t Z • N aro. J, J•).J, I k q I N N N M (N 3 N M �6 d M h O�OMMO�NO)�001� )cOiA00�rn0P O M tD •- h 0 0 0 N �' o"o f �� N .- ) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 MMMMMMMMMI�I�M � ', ) MMMMMMMMM�ptpM N N N N N N N N N — — N A Z W Z >- x )"n- *n(ow0 0;7 Z� H D N N N N N N N M M M M O Z f- 1-F- I- I I I Q'W =) Z � � )00000^000��') O j J J J J J N J J J N M M �"� u \ Z X SON °c RD SUB I .. _ _ _ .......... v) u L? Q W H J \ 2626.32 , LOT 3 LOT 56 1313.16' 1251.16 441.63' 187.79' 196.61' o co - - -- — \ i c 05 C co VL CV cn d � m N o o C\2 < C / O N co CQ // co .,�A0 \ O� O . �' 2 \ � • E c @ C\ d I N O I o C\2 O I I Mgt 1 i �� FS204�5 KATHLEEN H. WALSH REGISTER OF DEEDS State Bar of Wisconsin Form 2 -2003 ST. CROIX Co., KI WARRANTY DEED RECEIVED FOR RECORD Document Number Document Name 03/09/2006 l O:15AN WARRANTY DEED EX9PT # THIS DEED, made between B & L Land Development. Inc., a Wisconsin REC FEE: 11.00 Corporation TRANS FEE: 319.50 ( "Grantor," whether one or more), COPY FEE: CC FEE: and Michael R. Cox and Teresa L. Cox husband and wife PAGES: 1 ( "Grantee," whether one or more). According Area Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Name and Return Address interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is f 2��� u J� needed, please attach addendum): Lot 22, Plat of Sunset View Development in the Town of Troy, St. Croix County, Wisconsin. 040 - 1306 -22 -000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptionst warranties: Easements, restrictions and rights -of -way of record, ifany. Dated (SEAL) (SEAL) * B & L Land Develop nt, Inc. (SEAL) �— (SEAL) * s AUTHENTICATION ACKNOWLEDGMENT Signature(s) i , ' authenticated on STATE OF W — ) ) ss. COUNTY ) r <8 '&J(\ JA TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me on t§& bao (If not, the above -named B & L Land Development, Inc.. a Wisconsin authorized by Wis. Stat. § 706.06) Corporation to me known to be person(s) who executed the foregoing THIS INSTRUMENT DRAFTED BY:&'), \v '.� tspent and ckno g d h same. Attorney Kristina Ogland Hudson WI 54016 ! aA \�� C tary Public, State of My Commission (is permanent) (expires: (Shpatures 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 ® 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 Type name below signatures. INFO -PROTM Legal Fortes 800 - 855 -2021 www.infbpmforme.com IofI ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer C X // C L 6 X Mailing Address /�/� Property Address `/ O1� Y/V Z,C IVC o eu j Q l (Verification required from Planning & Zoning Department for new construction.) City /State / -1u,Q Sow (,�f Z Parcel Identification Number U yQ - / 3 0 (p - p7p? - 00 LEGAL DESCRIPTION Property Location '/ , '/4 ,Sec. , T c�S'N R _aW, Town of / A Subdivision So N S e/ V/ Lol # . Certified Survey Map # , Volume , Page # Warranty Deed # 8 0) 0 1 / 0 S , Volume , Page # Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Prope maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What yo u put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, sig ed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -sit wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the sep 'c 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 Wisc Dnsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County F lanning & Zoning Department within 30 days of the three year expiration date. 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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of 0edrooms Z?�z a / 3/ SIGNA URE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08105) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Peg _ _ of FILE INFORMATION SYSTEM SPECIFICATIONS — Owner + C �✓ Septic Tank Capacity d al ❑ NA Permit # --------- ---- -- -- Septic Tank Manufacturers ❑ NA DESIGN PARAMETERS Effluent Filter M ❑ NA Number of Bedrooms O _- NA Effluent Filter Model - C]� ❑ NA Number of Public Facility Units — -- - �NA Pump Tank Capacity `; NA - - - - -- -- - - - - -- -- Estimated flow (average) n � - - - -- al al /da Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) 0 gal /day Pump Manufacturer NA Soil Application Rate g al/day/ft' Pump Model Standard Influent /Effluent Quality Monthly average" y _ I NA Fats, Oil &Grease (FOG) 530 mg /L Pretreatment Unit �"A ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD.) 530 mg /L tRIn- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Cqliform (geometric mean) 510 cfu /100ml ❑ Dri p - Line p - 11 Other: Maximum Effluent Particle Size -- - - -- -- Y in dia. ❑ NA Other. - Other: _ - -- - - - - -- -- NA ❑ NA Other: NA "Values typical for domestic wastewater and septic tank effluent. Other: NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) -® ear(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ monthis► J3 year(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: // 43 month(s) l0 " ❑ year(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ year(s) NA Flush laterals and pressure test At least once every: ❑ monthis) Other: — ____— __. ❑ year(s) NA At least once every: 11 month(s1 Other: ❑ year(s) NA ❑ NA 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 Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection 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 to check for any back up or ponding of effluent on the 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 indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION Page of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tankls) 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 cellls) 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 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) water; 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 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 fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: co 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 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. • 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 timei Mina r° < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT., ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A' PERSON FROM THE INTERIOR OF A TANK MAY -BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTAL POWTS MAINTAINER Name T - Name Phone <� Phone' U SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name S C i t u 1 X r Phone — - Phone R 3 (� This document was drafted in compliance with chapter Comm 83.2212)(b)l1)(d) &(f) and 83.54(1), 12) & (3), Wisconsin Administrative Code. 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 or other chemicals that may impede the treatment process and /or damage the 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 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 cell(s) and may result in the backup or surface discharge of effluent. 7o 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) water; 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 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 fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has 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 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. • 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 thattimei hrea e.: < <WARNING> > SEPTIC. PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF X PERSON FROM THE INTERIOR OF A TANK MAYBE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name le- Name Phone 0 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name ` Name S � , C R u l x i Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. -� � -- — � I' I� �q 4 �b� q o . � � r ¢g � d S a AwMery MPIM i i i � — —_... 4 — � —_�_ _. �I — - - -- — - -- —' I �.s 3 b �� i 3 �i � � �'� ;� �I -' �� m �� � � � I � � s =�� - - .OA Via ' �Ti a fill op cp...,