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HomeMy WebLinkAbout040-1306-27-000 7 IF Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County. S• Safety z !d Bdilding Division INSPECTION REPORT sanitary Permit No 5062G. 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)]. I Permit Holder's Name: City Village X Township Parcel Tax No: Johnson, Luther & Patricia I Troy, Town Of 040 - 1306 -27 -000 CST BM Elev: Insp. BM If 3' BM Desc ' tion: Sectiontrown /Range /Map No: IL /oz 6 1 / 0 , f 0828.19.1854 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 1 Septic � � � � Benchmark Dosing Alt. BM Ay Aeration B ldq. Sew e �C. 1 12. 9,7- ZS Holding St/Ht Inlet 3.o:G -zy St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ` 1 1 D m l0 - L ft �S Dosing / r l ( ' '� H eader /Ma n. `7 dvQ 41 5.1PA 0.70 j Aeration D ist. � - pe d Z D ��• Holding Bot. SysferffJ r i G`7 S� Z /f Z Final Grade .�(� ' fi, ! • - OA PUMP /SIPHON INFORMATION / Q � Manufacturer 0 GtJ� b!/Y e an St Cover ! l© / GPM (� `f � / Model Number In (lyL IM Friction Loss System H TDH t (D <- Forcemain Leng h Dia. „ Dist. to W . el� 2' IA 1 SOIL ABSORPIrION SYSTEM Z( + Z 2 BEDITRENCH Width L�gt � No. Of Trenches DIME NSI No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 X11 SETBACK SYSTEM TO P/L BLD WELL LAKE /STREAM EACHING Manufa INFORMATION HAMBER OR Type f System: V rt 1►� i r UNIT Model Number: A lj&d� C) T.R BUTION SYSTEM V ►, i HeaderlM ifold Distribution x Hole Size x Hole Spacing Vent to Air Int e f Pipe(s) Length_IL Dia Length a Spacing l SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Q� Depth Over sss��� �� Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center �� BedlTrench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies persons present, etc.) inspection #1:__L1 y /v7 Inspection #2: Location: 431 Jordyn Lane Hudson, WI 54016 (NE 1/4 SE 1/4 8 T28N R19W) Sunset View Lot 27 Parcel No: 08.28.19.1854 1.) Alt BM Description = d rn �` �,T k, v U " L ` /L�O/f�.►��, SGtGt d 2.) Bldg sewer length = oqP� Sq� -LJ �� �"" Z - amount of cover = A4 & �u.�.� � -d / , -- N^+' -cam'- $dii2 -- Plan revision Required? Yes 1/ 0 1 0.1 ' Use other side for additional information. _ Date Insepctor' Signature Cer SBD -6710 (R.3197) commerce.vvi.gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 S4 C X ic onsi j1 Madison, WI 53701- Sanitary Permit Number (to be filled in by Co.) Department of Commerce ■■ 5 e ) (o Z b Z S anitary Permit A.pplicat10 StateTr�nNumber In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the a ropria nmental unit is required prior to obtaining a sanitary permit. Note: Application forms for star wne WT are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be d for e ry u rposes in accordance with the Privacy Law, s. 15.04(! )(m ), Stats. // �. ) D t W L Application Information - Please Print All Information cc < Property Owner's Name rcel # 0 4- PA- I?/e 14 °SO (4 WTblIVED n o _ 3ro 1. -z - 7- ocio Proper Owner's Mailing Address JPop erty Location P Y �IZS - o N t! AN' t. Lot MAY 2 4 2001 City S to Zip Code one Number y, S y. Section_ ST. CROIX COUNTY (circle one) ; R _ Eqeq II. Type of Building (check all that apply) p k L �I or 2 Family Dwelling - Number of Bedrooms - -d+0 -7 -- Subdivision Narne_ _ LLB r e-4� Block # rUA.J (�� 1 (�L✓ El Public/Commercial - Describe Use eJ4R_ ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of L *Town of T �Y III. Type of Permit: (Check only one box A line A. Complete line B if applicable) A. 01 New System y ❑Replacement System ❑Treatment /Holding Tank Replacement Only El Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. T ype of POWTS System/Component/Devi Check all that app 1 Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. ofsuitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application te(gpdst) Dispersal Area Required (st Dispersal Area Proposed (so System Elevation 7.467 6 f i �`✓�g J o���k 5� w o VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units Z ./L/� U New Tanks Existing Tanks t7/ o B y Septic or Holding Tank Dosing Chamber VII. Responsibility Statement - I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plunmb ''s Nanme (Print) Plumber's Signature MP /N+PR9•Number Business Phone Number w6-to ,J z z6 rl 7 1 71-5- 2 73 f XX Plumber' Address (Street, City, State, Zip Code) VIII. Count /De artment Use Onl Approved ❑ Di rove Permit Fee Date Issued Issuingb4t Signatur ❑ wne' rye son for Denial /56 • �� c/ / ` IX. Conditim-OW asons for Disapproval 8� Lo- 5 1 b do,, ptic f 1. Se. tank,. effluent filter and 3 \ 5 dispersal cell must all be services I maintained L p Go A4 j e as per management plan provided by plumber. ods' 2. AN sdbw* t6quirements must be maintained P C e,6 LX-- Q e, l (2 Attach to complete plans or the system and submit tot a County only on paper not less than S 112 x 11 czll�,t4k Af 6"-L inches in size SBD -6398 (R. 01/07) Valid thru 01/09 a PL 4- P L (A gN � -AJ y 7 � D IrTo f g t �v rg� L L P Z 27 J LL I P RIM /oso z �3 g PC, ° �3 ���✓��� �� Wisconsin Departme of FaIVED� SOIL EVALUATION REPORT Division of Safety a d Buildings Page \ of ni�AA in accord nce with Comm 85, Wis. Adm. Code • Attach complete s to plariroA�a 0 2 004 County t� . per not ess than 8 12 x 11 inches in size. Plan must o: very S C r v) include, but not Ii 'led, t a jc ntal r erence point (BM), direction and percent slope, s e or Z�� �l aow, ar d location and distance to nearest road. Parcel I.D. l ease print all information. Rev ewed by • Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner ZZS Property Location 1 — �V 1/45 1/4- S T Z N R Property Uwners Mailing Address E (oO W Lot # Block # Subd. Name or CSM# P • o. Sox 3 3 1 — I S U Y'--Is City State Zip Code Phone Number ❑ ��M City Village Town Nearest Road 3 �Rk..� Iv ► 5 �1 g - 1 p New Construction Use: ® Residential / Number of bedrooms — �4 Code derived design flow rate S C) — Ub Replacement GPD ❑ p cement ❑ Public or commercial - Describe: Parent material G t_�e) )4 Flood Plain elevation if applicable General comments ft• and recommendations: ` D � S "J/) O F ��LS �U `� �� S U C� r� a -Qe+1q w.ti� Ce.e+N.S I © Boring # ❑ Boring ma ® pit Ground surface elev. 00 . ft. Depth to limiting factor 4 y in. Horizon Depth Dominant Color Redox Description Texture Structure Consisten Soil Application Rate in. Munsell ce Boundary Roots GPD /ft Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 `r rl Wl V i �S — S - .( y o -9L/ ) oaf IZ (4 /6 tt i Boring # ❑ Boring ® Pit Ground surface elev. )u� - ft. Depth to limiting factor '7 0 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. � _ly ) 0�[4Z 31 'Eff #1 'Eff#2 Zm Sb rn cs S .g 3 �Z 9S 1 II` V16 1 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 m g/L and TSS < 30 mg/L _ Sign lure CST Number -Arthur L Wegerer, 220254 Address W e g e r e r Soil T e s t i n o Date Evaluation Conducted Telephone Number 421 N. Hain St. River Falls,UIg54022vice \Z —1 —03 715 -425 -0165 Property Owner Et ` `'���� ( �M &j'T Parcel lD # J'17) /IJ Cj Page 3 of Boring # 11 Boring g ® Pit Ground surface elev. 2 ft. 7 S Depth to limiting factor 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 D - \Z 1 p 2312 - S i 1 s b 12 Y►� `FI- t.v .tP Z 1 z -�[ lost e 31 - s i I Zh, s 3 (-13 SIS 1 0`1 R Vh, - S 0 a 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. Soli 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 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. SBr -8330 (R,6100) Property Owner � ` w�� N ( 7 Me"/ Parcel lD # V :Z , ,, 7) hi Page � ' of a E] Boring # ❑Boring Pit Ground surface elev. I 0 • 2 ft. Depth to limiting factor S 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. •Etf#1 'Eff#2 I L) - `'12312 _ a l � zFs W► -4. 0 IL )olt e 316 Zw, S bk c s �I3 q ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Csistence Boundary Roots GPD /fl on in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 I I, Boring # 1:1 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 Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD < 30 mglL 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. 5©[)-8330 (R.6/00) Wisconsin Department of Commerc SOIL EVALUATION REPOR Division of Safety and Buildings Page of in accordance with Comm E5, Wis. Adm. Code Attach complete site plan on pacer not less than E 1/2 x 11 inche s i size. County include, but not limited to: vertical and horizontal reference point (BM),diirect on and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Para! I.D. Please print all information. Reviewed by . Date Personal information you provide may be used for secondary pur~cses (Prvacy Law, s. 15.04 (1) (m)). Property Owner l Praperny Location 1/4 ?C 1/4- S � • T Z�j N R 1 � � Property Owner's Mailing Address r E (Or) VV Lot # Block # Subd. Name or CSM; � • o. Sox 3 3 1 City State Zip Code Phone Number I U`�v Si - v ( `'� � �� , City ❑ Village � Town Nearest Road jL0 c'-- — Frecommendations: ction Use: ® Residential / Number of bedrooms — L! deri Code ved design flow rate GPp Public or commercial - Describe: G {�C) 1 ;L �� Plain elevation if apcii�ble ts ations: \` u jvl ; J t S Lv /1 nJ , j IZ Lam, r C a Boring ; ❑ Boring ® pit Ground surface elev. 1 00 , ft. Depth to limiting factor y in. criZOn Depth Dominant Colorl Redex Description Texture Structure Consistence d Soil Apclication Rase l ( e ce Bounary i Roots GPD /{t2 in. Munsell Qu. Sz. Ccnt. Color Gr. Sz. Sh. 'EffR1 I 'Ef f#2 •S Boring # ❑Boring ® Pit Ground surface elev. i ' ft Depth to limiting factor in. Horizon Depth Dominant Color l Redex Descri Lion Texture S' Soil Application Rate Description l truc.ure i Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff; 2 S t ' ft !(, rn � /6 � J s 9 I ' Effluent #1 = BOD > 30 < 220 m > s g/L and TSS 30 _< 150 m = 9/L Effluent #2 BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sign cure — Ar thur L (degerer csT Number °�. �3 Z1S — Z� 220254 Address W e g e r e r S o i l Testing & D e s i g n S e r v 1 C e Date Evaluation Conducted Telephone Number 421 X. Main St. diver "r'alls, 1 - 54022 �Z -1�_p3 715 -125 -0165 PLOT PLA -N Paae of Scale 1' I i t I LuT i Sv S L c p F2 ' uv In ft kwp FCL�Rl7� Ct �� X05 LvY z.$ �° � a• z. r I i - 1 �, QUO -a aw �1'Ttit_C., Sly ° Dt/�_ PVC \�tp�� /LAt{ , >Z_ 03715 425 - 0165 220254 0 Z -Z7 CST Signature Date Telephone No. CST No. Job NO. r10RI1EAI1 CORNEA, NOT. y CSY I,wp L01 7 CSu SCfIIp! a, fO1N0 Sql 5 r6 1JW S'CROII CCAMfr - - -- -- _ kwwfNJ SUNSET VIEW 1 - - - - - -- ONP --- LANDS - - - -- �___ � S W560eE U1J.16' o N l�SY2Et WIN1 -- 1NCTH x "F W - - - -- DEVELOPMENT ; CTH RD. FF" y N 655 rmt 10220 8---- -- LEGATED I IRE SW 1/4 O INf NE 1/4, X SE 1/4 OF TIE RN 1/4, ''.. 1BJ 06' Tp�r "� THE LAW 1/4 OF ME SE 1/I AM IN THE NE 1/4 OF THE SE 1/4 OF z YISON 95037 SECTION e, URA, R1911, a , TM III 51M COURt, MO. �; % s; C • _ _ 'S aw1U[E 1 rAwBAf / ' w I N ^ CURVE WA TABLE n X I) n t IrI err 1 1 19 X lr ' I . Y x'911' , x 57 w' nx 1ka I , ,( p ) 311.9 571016 5710 x N I 2 1w T' "xlidsii " " "ikii "'8 N S L5 97a 207 377 6 20310 x Rm' I A1L 5 RAGE 171' 51 : 0 7J 1 1 J7' o pYlWl ,�� LOT 2O u \ J 1 1119 us 37,17 xN A41J t W I • x w'Dm' f 1 x 512 - t r 'RM1 1011, SI 1J3A0' qIA IiRC 101 'W01'r ns•Nk1 Sf 5 Ya 1 pk91` 8 LDT 19 9'. N- 9.9109 I A 1.1 ww 1211' nee IS 6117 XllaaY 1t.xakm'I IT 0•1 RAW) .OI 1 j U m 113 . wlm' 3 f 29e507 . 9 5.1 wW' 9379' Pva'w' n5a' 6rtTA't n 1 . v M" r u 9 5 139 • " t n 5 'T' ( 6.91 k. a 7 13x '611' 'rote 169 n Da05 870 S Y 254.F. I W LOT �Y m.0' 171.77' waa' Inrf NIran•t 5.85 Ac. Z Q ' ,a A 135 130' 1554C 11 X5 ID.u' sRn'n I 1 T La 1 1300 02651 51'511' A1.10 S tnf7' r 7 / • }+ 1 LD•1 Lei 0 Y x vo' paw i 1 A 1 1 P47' 312. 1321 s R1s'7 ;t Anl . x 511311' t o• s aaro2' r 1 8 ___________ � y I -11 11 a' nN'w' I i1A w ' xf�M1M; lI n I0• SOfa'a 'N AI 11 . k'N76'f Q t �'_ _- __ -___� .. .. ISa'm' 61.9 S R1Fal N Al 9• S 59911 r I I I Ian nu'w' Sw - 501 Iw.,oa.a' I `A 11 1 21300 117110' 9axr ".7 11 . S 919'26' 1 i!' s ion sn 71176' �. LOT 23100 IOlm INV lair X04077] t ' +' C LOT 9 IDa' 55'2 1 6a'a 1370' N m'ef21' I yk� LOT lB 5 N 59'56 a _ n Is.A 1vw' ne O' H715r 15x37' s x5370' 0 n s . s Iin1r 1 1! se . s 1ra'k t D -- - -- � ; { V ;1 24 9 sr -- - - - - -- O 0 v n Rm in 21 cif s 13755 L- - -___ t - -- WON' 6711 5 w11'S7' t 762 k. ^ r _ _________ 135X 117.11 SRII'0 1'F n I • S1Ya'H'[ 11 n•awJ7'D'[ \ V 76 o �- a 19.20 woor 7915' '3351'17' X17.76' X Ra71' [ 11 19 • x a7YD' I LTA • N 111130' A @6,1 A i ll -i7 I13a' Iww 005'x' "Do N 7rkw' 1 AT 11 .091 19' 1 n 7 • a 01 [ k le t1N Ox IJ752 OT A17 7171 w'I IT 23 !10910 A.191. S 11130'1 LOT 21 7s 74 m0 k 03151 1137 s rrsrN 50.5.13750 ua•saaD'. x77 2Dx Ip.a 2633711 100.9' s I•a u•t 10137 tllw 10130' lark arc San'N't A LOT 10 0.96x' 9 . �v 32na S! LO 1 9130 a0 055 726 ' s av r 13725.1 SENw I uk. 4 G Loll130 130' 11 ma sACKTO 13 1 6,77 k. A'r �� 1 I \ 10116 Woo 11110 27BY Lila 7Rq D'Y `' %a 1 \ j 11.21 23300' 177a 16'A'se' 11111' IT wrol• N AI p . S aIYlY, r k a • N Ra'N' r LOT 21 law laa' File 1125 x Ra'a' 1 701 a 11370 1217 aaa' Ink' N wa'71' 1 LOT D wa' 5111' ISlllf go, N 2615'51 R i's 19 -w a 167.5 19110' m'D' 110., x5151 5 1 n 11 •N 175 k' 11130 11 •x 97 1 w. svxwtl 48." N I ? t su1)1n m0 413' 9a'w uv 7z, 5 '1 IT •x479 a•A 11 n. sa Y 77-k ww 1511, IN 21' 1657 SA IT n.s17)1 xnI Air 35. [04.411 51751711 A,, � u -�i_. __!a,N' ���11m r / %��i 656 1 '' •� ' Vi a. 500 -27, �C}s' - - �ORDYN iJ�'E agy4> �, �� A �. ro �• �\ ' LOT 11 5 ) ID 40BW S.F. A LOT 34 r 26` q1B� • V V r J \ X 70 �i 6594 sr ° s LOT 33 �, °o. H 6 LOT 11 55637 sr LOT 22 I9 A0. k E' 6655 9.1 1 x , L 12 : IJI k $137 SF. S 58 Ac n '- 53333331 S F 1 - p', �R \7 ^ 1.12 AC 0 V Lw.1ox /h .`-4$.�g ISA A597611t 70791 !v 6 ®� �___ ,,, ReW ReOaEjxuwg6Y rlY x13 apxlW o : o� 16126 13.65 / 1 Sm 06.0,1a16.215RNd7JUIQlad(IJ 1 ), n i 0 $ 5 I 11. -- - '1 - -- t • A 5 65'X 13 Jp E -- _ WIT 14". b - - 15) Wool �we.l9ea,'ti 7 v. fi 1 �g��05 -I 0 2 1 e / i; LOT 1410 I LOT 1511 g1LOT 161 1 LOT 23 1 6 Z c�a�,'d� L,, ° _ a 1 LOT 13 ;W�SUSS.r� sl9as.r. lm ..*nn�-- 1 99.12 �` LOT 1 ; 17605 9F N65E 5.f I g ` EAST 1/4 CORNER, m_so 3 4139 sr- N Ig ^ 1,60 A 9 k. SECTIN a, mono I 144555 S.F. 1.00 k I' 1 it At 8 La k. Na 102 A < - 1977' I T. 2' 9 e' LOT 24 r aOJl'72 t 01.9' � a hh4 LOT 31 /9 •/� 1 S997717A 4319' 1. / ti 206 Ac. 43q37; 'Sy00 N6AN �IOO }f.1�/ 1 17777 F. 1513 JOESk 117 L6 ) U 191 2W60 (� a �% J A p A WINER 6 "=Ion r 4 dw 9f.C100lMtl IW SE J a �o 5� wr.un� rrdrr�r.11..y 6665657 n / Iq • 610765E �� D 1pl!Ir :1.111 55 k e ; 29 �ry LOT 2B LOT 27 '1 LOT 26 1 I, 140 AA. \ \5 \ u v -��•1v 1 /y 4 175999.P. ;� 1554 S.F. IN 476051.F. a 17177 SF. I I $ ' '\ o ° r ¢H i•hrsy wA. CU EI 100 A, 10 I 1.05 k. 1 109 At. 105 k. L - I - - __ L _ S Y 1917 -_J / � __ _ �__�_� _ � � � � �QAJ(j, •S� mlai 75010' 737.07 - 22605 ^ - U 1440,85' NOR: RD= Aw ®90M to TIM RSI NE -SE UNPLATTED LANDS $o k r I]W Of 16 a 1/4 IwLeu rims tx1000rt10110 0 100 200 i aw SO0'NCAST CURNER, ��♦ SE @ON 9, FOURO GRAFNIC 9cua - 173,7 SHEET 2 OF 3 Sif901I =1Y 4oN1a1N 1 9,1,1X0 THIS INSIRUKNI DRAFIrO 2r J4LRES R VESER 1 , l 111111 I!l!1 lull lilll 1!1!1 IIIII fill ill1ll llii Ilil * 8 5 0 8 5 3 1 850853 STATE BAR OF WISCONSIN FORM 2- 2000 KATHLEEN H. WALSH REGISTER OF DEEDS WARRANTY DEED ST CROIX CO., WI Document Number RECEIVED FOR RECORD THIS DEED, made between Brason Builders, Inca Minnesota 05/18/2007 11:10AN Corporation, Grantor, and Luther S. Johnson and Patricia A. Johnson, WARRANTY DEED husband and wife, as Survivorship Marital Property, Grantee. EXEMPT I Grantor, for a valuable consideration, conveys and warrants to Grantee REC FEE: 11.00 the following described real estate in St. Croix County, State of Wisconsin: TRANS FEE: 253.50 Lot 27, Plat of Sunset View Development in the Town of Troy, St. Croix PAGES: 1 County, Wisconsin. Recording Area Name and Return Address: Edina Realty Title, Inc. 400S.2 od St. — Suite 115 Exceptions to warranties: Hudson, WI 54016 Easements, restrictions and rights -of -way of record, if any. 800735 040- 1306 -27 -000 Parcel Identification Number (PIN) This is not homestead property. Dated this I Itit clay of May, 2007. Beason Builders. Inc. B * Torgerson, Vice President A ENTIC&TION ACKNOWLEDGMENT MM Signature(s) _ g STATE OF WISCONSIN ) State, ST. CROIX COUNTY. ) Ss. authenticated this 11th day of May, Personally came before me this May 11, 2007 the above named John Torgerson, Vice President, Brason Builders, Inc., * A Minnesota Corporation to me known to be the person(s) who TITLE: MEMBER STATE BAR OF WISCONSIN executed the foregoing i strument and acknowledged the same. (If not, _ authorized by § 706.06, Wis. Stars.) ea"a=� THI, INSTRUMF.N'r WAS DRAFTED BY *Pamela J. Gouiet Notary Public, State of Wisconsin Peterson Fraro & Bergman — Steven H. Bruns My commission is permanent. (If not, state expiration date: 50 East Fifth Street, St. Paul, MN 55101 10/11/2009 ) (Signatures may be aL1thentic2ted or acknowledged. Both are not necessary.) *Names of persons sitning in any capacity must be typed or printed below their signature N ARPLANTY DEED STATE BAR OF WISCONSIN FORM No.2 -2000 toff 08/11/00 FRI 13:12 FAX 715 386 4686 ST CRX CO LUNING WJVVL ST CR OIX COtTrM SEPTIC TANK NANC$ AGRBBM RNT AND OWNERSIUP CBRTlplCATION FORM owner/Buyer LttT ...._ ..._. Mailing Address Proporty Address p attment for new ooastruction) aCVL=�uired from Planning eP r 5qo �a 3 City/State �' N �"" Parcel Identification Number GALA SCRIPTION 2C� C. r Sfr: a S R tR W, Town of Property Locatio>� /•, � ' / {, Sec. T-- Subdivision Si= l c ELL) p,� �,v +'. Lot # 1 '✓ '' Volume rtifled Survey Map # - . Page # p4A. ° fro 0-!� 3 Volume Page # Warranty Deed # Spec house O yes Ono Lot lines identifiable gyes ❑ no S'r'EM A►i1VTEN_ANCE �aturefailure to handle wastes. Proper Maintenance S1' Improper use and maintenance of your septic system could result is its P a licensed pumPei. What You put into the system consists o f pumping out the septic tank every three Yu or sooner, if n,eededbY can affect the function of the septic tank as a treatment stage in the waste disposal SYSt"90- ed b the owner and by a t a ratification form, sign Y The Prnpcity owner agrees to submit to St: Croix Zoning D that (1) the on -site wastewaterdisposal system Plug.]ourweyzn=Plumba, r estictedpiumbetoraliemsedp um P erv= i4ing th teptio tu& is less than 113 frill of sludge. u in proper operivag condition and/or (2) after inspec and pumping (i tem with the ctandsrds agree the private sewage disposal sys �itiScatiou IJv+e, undersigned have read the about of re and Com =ce and the Dep�� of Natural Resources, State of Z g o set forth, heroin, as set by the Dep be iataincd must be completed and returned t0 the St. Croix County Z within 30 statin t your septic system been uia des the three ex p' on date. (1 �� DATE GNAT UP E OF APPLICANT 0WNI;R CEIL'I'IFICATION our Irnowledge. I (we) am (arc) the owner(s) of the I (we) certify that a ll statements on this forma recor in Register of Deeds Office. tore pro rty desenUd a ve, b virtue of a warranty �' _ DATE S NA OF APP I CAN T' « «t••• t bring revoked by the Zoning Departai ent. .. +«•+ A information that is mis- represented max result in the sanitary permi creation: a stamped waaanty deed. from is Register of Deeds offices •• Include with thcs app a copy of the certified survey map if refcronoo is made is War ranty decd L- 7 �s� 1 z19 _ 3 au(u- V"I uick4 w d C r-Cc- 1 STANDARD CHAMBER 52" Quick4 Standard Chamber 46' L '�- i (EFFECTIVE LENGTH) 0 12 34" SIDE VIEW SECTION VIEW MultiPort End Cap P 16' 12' 34" SIDE VIEW TOP VIEW FRONT VIEW AN 1 11 1111:111 ,6 lc i INFILTRATOR SYSTEMS INC. STANDARD LIMITED WARRANTY (a) The stnxtural Integrity of each dwrd w., and plate, wedge and other accessary manufactured by Infiltrator (•UNtsO, when installed and operated in a leachfiaid of an onshe septic system in accordance with Infiltrator's Instructions, is warranted to the original purchaser (•Holder' against defective materials and workmanship for one year from the date that the septic permit is Issued for the septic system containing the Units; provided, however, that it a septic pemtit is not requ4ad by applicable law, the warranty period will begin upon the date that Installation of the septic system corturneroea. To exercise its warranty rights, Holder must notffy Infiltrator in writing at Its Corporate Headquarters In Old Saybrook, Connecticut within fifteen (ts days of the staged dated. Infiltrator will supply replacement Units for Units determined by Infiltrator to be covered by this LYNted Wemanry. / • Infil rator's liability specifically excludes true cost of removal and/or Installation of the Units. THE UMfTED WARRANTY AND REME M SUBPARAGRAPH (a) ARE I. THERE ARE OTHER WARRANTIES RESPECT Q T SYSTEMS INC TO THE UNITS, INCLUDING NO tMPfJED WARRANTIES OF MERCHANTABILITY TY OR OR FITNESS FOR A PARTICULAR PURPOSE. (c) This Limited warranty shell be void ff any pert of the chamber system is manufactured by anyone other than Infitrata. The Limited Warmly does not extend to inddenl, consequential, special a I died damages, Infiltrator shat not be gable for penalties or liquidated damages, Including Toss of Environmental Onsite Wastewater Solutions'" production and profits, labor and neterlels, overfeed costs, a other losses or expenses Incurred by the Holder or any third parry, Specifically excluded from Unned Warranty coverage are damage to the Units due to ordinary wear and tear, allocation. accident, misuse, abuse W neglect of the Units; the units being subjected to vehicle "ift or other conditions which are not permitted by the Installation Instructkns; failure to maintain the 6 Business Park Road - P.O. Box 768 minimum ground covers sat faith In the Installation Instructlons; the placement of hVMW materiels Into the system containing the Units; failure of Old Saybrook, CT 06475 Me Units a the septic system due to Iproper sling or Improper sizing, exces" water usage. Improper grease disposal. or Improper operation; or any other event not caused q' Infiltrator. This Limited warranty anal be wild a the Holder rails to comply with au of the tamna set forth In this United 860- 577 -7000 - FAX 860 - 577 -7001 Warranty. Furthel In n O event shelf Infiltrator be responsible for any loss a damage to the Holder. the Unts, a any third party resulting from Installation a ship- �00 221 - 4436 Mont. a from any product liability dolma of Holder or any third party. For h an this Limited Warranty to apply, the Units must be Installed accordce with at site conditions required by sate and local codes; all other applicable laws; and Infiltrator$ Installation instructions. (d) No representative of Infiltrator has the authority to flange a extend this United Warranty. No warranty applies to any party other than the odgi- nail Holder. The above represents the Standard Limited Warranty offered by Infiltrator. A limited number of states smd counfies have different warranty require - ments. Any purchaser of limits should contact InfNtratces Corporate Headquarters h Old Saybrook, to prior te such copy d the applicable warranty, and should carefully read that womanly prior to the purchase of Units. � to obtain a U.S. Patents: 4,759,661; 5,017,041; 5,156,488; 5,336,017; 5,401,116; 5,401,459; 5,511,903; 5,716,163; 5,588,778; 5,839,844 Canadian Patents: 1,329,959; 2,004,564 Other patents pending. Infiltrator, Equalizer and Sidewinder are registered trademwks of Infiltrator Systems Inc. Infiltrator Is a registered trademark in France. Infiltrator Systems Inc. is a registered trademark In Mexico. Contour, Contour Swivel Connection, Microl-eaching, PoyTuff, Snapt-ock, ChamberSpacer, Posil-ock, QuickCut, QuickPlay RECYCLED PAPER and Quick4 are trademarks of Infiltrator Systems Inc. 0 2003 Infiltrator Systems Inc. Printed in U.S.A. 0011203HP -0 "/' S D �l Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number Numb of Bedrooms Design Flow - Peak (gpd) 6 o Estimated Flow - Average (gpd) 40v Septic Tank Capacity (gal) f Z p9 Soil Absorption Component Size (ft 4 °' Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) U� 0-0 Maximum Influent Particle Size (in) 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component . filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep- rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. PL AP- qeL sa /J P�, .9 6 71.5 4 M(5 co Aj c + 71.E 6 4' -7 3 COMBINATION SEPTIC/DOSE CHAMBER TANK & PUMP SPECIFICATIONS PER COMM 84.25 CODE CHANGES 2/1/2004 Access Opening, not top of cover, Access Opening, not top of cover, must extend to a point no greater must extend at least than 6" Below Finished Grade 4' Above Finished Grade . S' o l l� r Cover with wvZA n Ells - Y 1�T 112, V Zrt-� Lockin Device ��' . 6 89' ppe0� CAP (ty I Finished Grade t vi wwJ6r Min. 23" > 30 tfi >�Z �a Access Opening i Ole. LA*6 1 Min. 23" Access Opening i ,2 "1 nit mmoffil Outet Effluent Filter Union jQi2oYEP P/ R6 3 Pl. Inlet Baffle i C � Pu p ��r V u n e r �� 6 y . W / � een; r 2" /aue-r SIha h erg's' 3 .Sa�'►d °`" �' Two Com aftment Se tic/Pum Tank �� a � ✓✓ J �4o ) P P P kz 7" ei�OA on Ov�side GCKcI�f) SPECIFICATIONS TANK MFR: G✓�� DOSES PER DAY: TANK SIZE: SEPTIC GAL. DOSE VOLUME: GAL. DOSE GAL. (INCLUDES FLOWBACK & <20% OF DWF) ALARM MFR: +'j_'V K l k'rp - q CAPACITIES: A = 0 3 INCHES = GAL. MODEL # Switch type: B = — 2 — INCHES = ��, 2 GAL. PUMP MFR: � L Id C = _INCHES =GAL. MODEL #: 4el SWITCH TYPE: D = INCHES = 2 3 GAL. REQUIRED DISCHARGE RATE _GPM PUMP & ALARM WIRING PER COMM 83.43(8)(e) r/ 9. 7 �o VERTICAL DIFFERENCE BETWEEN PUMP OFF & DISTRIBUTION PIPE (LIFT) _ /0, FT. MINIMUM NETWORK SUPPLY PRESSURE (DISTAL & NETWORK PRESSURE) = + C2 FT. T O FT. OF FORCEMAIN x 33 FT. /100 FT. FRICTION FACTOR ...... = + 619 FT. TOTAL DYNAMIC HEAD (TDH) = FT. INTERNAL TANK DIMENSIONS: LENGTH ; WIDTH ; LIQUID DEPTH MP/MPRS SIGNATURE: LICENSE NUMBER: APR -12 -2005 16:28 FERGUSON ENT HUDSON 715 386 6144 P.01 [gGOULDS PUMPS ubmersible L '-° EFluent Pump : PE 4 WW MT rum,. SPECIFICATIONS MOTOR FEATURES Pump — General: General: ■ Corrosion resistant • Discharge: 1'A" NPT • Single phase construction. • Temperature: 104 °F (40 °C) • 60 Hertz ■ Cast iron body. maximum, continuous when • 115 and 230 volts M Thermoplastic impeller and fully submerged. • Built -in thermal overload pro. cover, • Solids handling: Ih tection with automatic reset. ■ Upper sleeve and lower maximum sphere. • Class B insulation. heavy duty ball bearing APPUCATIONS ' Automatic models include a • 011- filled design, construction. float switch. • High strength carbon steel s Motor Is permanemly Specially designed for the • Manual models available, shaft, lubricated for extended following uses: • Pumping range: see PE31 Motor service life. • Mound Systems performance chart or curve. • .33 HP, 3000 RPM ■ Powered for continuous • Effluent/Dosing Systems PE31 Pump: • 115 Vohs operation. •. Low Pressure Pipe Systems • Maximum capacity: 53 GPM • Shaded pole design ■ All ratings are within the • Basement Draining • Maximum head: 25' TDH PE41 Motor working limits of the motor. �.. • Heavy Duty Sump/ 0 Pump: • .40 HP, 3400 RPM Quick disconnect power Dewatering • Maximum capacity: 61 GPM a 115 and 230 volts cord, 20' standard length, • Maximum head: 29' TDH • PSC design 115 or 230 S T w iit PE51 Pump: PE51 Motor. • Maximum capacity: 70 GPM .50 HP, 3400 RPM ■ plug oplete unit is heavy duty, • Maximum head TDH 115 and 230 volts portable and compact. METERS FEET • PS design ■ Mechanical seal is carbon, 40 , r - , ceramic, BUNA and stainless PE51 I I ..I MODELS: K31, PPA1, PEST steel. I.. I I I . ' I l 35 _ _ ■ Stainl r _ a HP:.33..ao, .50 ss steel fasteners. 10 I ! ' 1 I T- -J. I 1 I -s 2 W I I , , 30 •�E4 ' • i 1 1 i I I I AGENCY LISTINGS 1 . 1 �, I 1 Fr z 25 s�0 a 20 I I 1 'i. '� I �,, c us I 1 Tested to UL 778 and h s 1! I I I I I I �� 1 1 I �_r I_ ' 1, CSA 222108 Standards 1 I BY C StarWW& Anodation File #L rAq 10 i 1 —+, „� _ i I • f i Goulds Pumps is ISO cool RegL.Ured. 5 4H I I 1 i I 1 'I - I I i �. I, I I, 1• I i I t �I.. I I I, ,I i , I I � I i l I I • 0 0 0 I 10 20 I I 30 140 50 60 70 GPM 80 0 5 10 15 m Goulds Pumps ' Z 004 ITT Water Technology, inc. CAPACITY Effectiva,une, 2W4 ITT Industries �E3 T/41