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Wisconsin Department of Commerce: PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division y INSPECTION REPORT sanitary Permit No: ": 463441 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: Bast, Kernon I Troy, Town of 040 - 1289 -80 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 18.28.19.1652 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic LS O Benchmark , / t I z �a ` ' Dosing Alt. BM Aeration Bldg. Sewer 9'3 �� OSr Holding St/Ht Inlet , 0-+ r '1 Y- s3 St/Ht Outlet p -31 TANK TANK SETBACK INFORMATION ' 3q 3I TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ' So r � � Dt Bottom Dosing J Header /Man. /9. ZD p Aeration IO,45' r s 3. Holding Bot. Sys a e/1 11,92— 2 b r Final Grade �" r PUMP /SIPHON INFORMATION Lxs+ g Manufacturer Demand S over P Model Number TDH Lift Frictio oss System Head TDH Ft Forcemain L gth Dia. Dist. to Well SOIL ABSORPTION SYSTEM R NC Width / Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIME S 3 3 SETBACK• SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufa urea ` INFORMATION CHAMBER OR Type O 8�em: y'! i 4 �� _� UNIT Model Number f r / DISTRIBUTION SYSTEM J GIL 1 Header /Manifold , Distribution x Hole Size x Hole Spacing Vent to Air Intake QS Pip s > L Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed/Trench Edges Topsoil Yes l i r' No Yes No OMMENTS: (Include code d' cr ncie persons present, etc.) Inspection #1 SWR - 15 /. � Inspection #2: � - 7&0 Lo cation: 365 English Court Hudson, �WII,{5.4 6 (NW 1/4 NE 1/4 18 T28N R19W) English Estates Lot 8 Parcel No: 18.228.191652 1.) Alt BM Description 2.) Bldg sewer length = 2 0 (r 1A -UA l plf Q ^t aJ1ll0.. - amount of cover = 4V r � �) 3) Plan revision Required? Yes /yam No ) 5- / Use other side for additional information. �_I - - - - -- - Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) Safety and Btlo Division County _ - lUl W, W 'a.snuigton f ve., P.O. Box 7162 Isco ns#n Ma a is 1 53707 — 7162 Sanitary Permit Nom (to be filled in by Co USj' F -- Department of Commerce Sanitary Per Tt"JWZONIN n state Plan LD. umber In accord with Comm 83.21, Wis. Adm. Code, j ro may be used for secondary purposes Privi)` 1��� Project Address (if different than mailing address) 1. Application Information - Please Print All Informa N Tr CE 3' , Property U vn 5 Name flu cu l # Lot # Block # Proper Owner's Mailing Address Property Location e ��) 9-h 6 F llG - �� 0L_� 'A, �%y Section Crty,'tat �T Zip Code - Phone Number __ (circle QAQ II. Type of Building (check, that apply) *1/I or 2 Family Dwelling— Number of Bedrooms _ Subdivisiun Name um Public /Commercial — Describe Use y/ _j State Owned — Describe Use ElCity ❑village wnship of III. Type of Permit: (Check only one box online A Com plete line — B if applicable) A. New System T � Replacement System r L ! 1'reatmenul folding Tank Replacement Only El Other Modification to Existing System I B. Q Permit Renewal JJ'crrnit Revision ❑ Chunge o1 1'errnit'1'mnsfur to Ncw List I'ruvious Permit Number and Date and Before Lxpirution Plumber j Owner W/ Z �I V.TyPe of POWTS System: Check all that a I _ Non — Pressurized In- Ground ❑ Mound?: 24 in, of suitable soil _, Mound <24 in. of suitable soil ❑ At -Grade ❑ Single Pass SwW.Filter 0 i,auuctcd Wetland �] Pressurized In- Ground lolding "tank Peal vilw ❑ Aerobic "Treatment Unit U RwrQuiating Sand Filter U b (gp b kcr ireulaun b S nthctic M edia h'iltcr Leachin � C h unbci i_' ri J u u J Uraveldess Pipo � Other (explain) �V Di ersalll' reatmentArea Information: f S- ihsi n blow d) Design Soil Application Ratct6pdsi) 'PC rs2l 1trca 2�c,qu red (sf) Dispersal Area Proposed (A) System Elevation V1. Tank Info Capacity in Total I Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units 1 Concrete Constructed Glass New L'xiating I TardcS ' Tauks �prw x ltold�ng 1 arik Dosing Chamber ~'-- — j-- --- - -_.__ 11. Re pon ibihty Statement- i, the nadersigned, ass me resp oasibihty tar i of the POWTS snows on the attached plans. Plumb s e grint - Plumber' P/MPRS Number Business Phone Number I C z uj �V ➢ r ;oun�il)etoart rnen ( Use nIY _ Approved t� Disapproved Sanity Permit Fee includes Groundwater Date Issued Issuing prat Signature (No S pri) -�, Surcharge Fee) r . + orttiittons of Apprt via" 0 SYSTEM OWNER: Ck_ r to J 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. o✓�o� 2. All setback requirements must be maintained as per applicable code /ordinances. Attacit cotaplete plans tic the COUG; only i for the s;-gtein on paper not less t6aY stl2 x fl 1 inches m sis� St3u -6398 (ri, 01103) , m ' a $ - b Ci II N i l Q copy ga a �4,t I \� 4 � e Q '4 � � 3� Wisconsin Department of Commerce S O REPORT Page of Division of Safety and Buildings accordance n M rr�� i with s. Coun ty Attach complete site plan on paper less ; in s' . Plan must include, but not limited to: vertical an horiz point (BM), ction and Parcel I.D. percent slope, scale or dimensions, rth arrow, and location and distan to nearest road. Please p nt all t4o� 05 eviewed by Date Personal information you provide may be d for seconds u o �s (�Fiiv�cy L , s. 15.04 (1) (m)). ��, S S Property er ZONING OFFICE Property Location Govt. Lot 114 1/4 S T N R E (or)f Property Owner's M )ling Address Lot # o Subd. Name or CSW Q � . City State p Code Phone Number El CRY ❑ Village OTown Nearest Road ( ) Z �( New Construction Use: Residential /Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material _ /9/1 6V< / Flood Plain elevation if applicable ft. General comments and recommendations: S�rs ��°i 9-,2 9 F-/ I Boring # Boring pit Ground surface elev. Z& / _ ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 •Eff#2 .J � Q Boring # Boring R Pit Ground surface elev. /D /, D ft. Depth to limiting factor �1�/�_ in. mil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff; in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2 * Ejluent #1 = BOD > 30 220 mg/L and TSS >30 < 15 g/L * Effluent #2 = BOD < 30 mgA- and TSS < 30 mg1L CST Pri _ Si CST Number Address ate Evaluation Conducted Telephone Number xrp 1 I Property Owner Parcel ID # 6 Page �2 of _ Boring # Boring Pit Ground surface elev. //91,,,2 ft. Depth to limiting factor 11,,5 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Efr#2 a g 9 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/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring # ❑ Boring ❑ 11 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/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Efr#2 * Effluent #1 = BOD, > 30 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD 5 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. SBD -8330 (R.07 /00) M �0 f T7 I i 1 i � e may � tz , tA 4 \tea 1 W � v 1*6 Safety and Buildings Division ounty W 201 W. Washi t,., ' evnsln Madiso , WI anitaiy Permit Number to be filled in by Co.) Department of Commerce ( 8)266-3151 Sanitary Permit Applica ionAP to Plan I.D. N/u(m�ber In accord with Comm 83.2 1, Wis. Adm. Code, personal info on jjj�2� may be used for secondary purposes Privacy Law sl 041 ect Address ( B if different than mailin 1 „ address ) I. Application Information — Please Print All Information Property O is Name 1 Parcel # Lot # Block # Property ` 's Mai Addres P wner $ Property Locaton V.., Section _M City, S e Zip Code Phone Number AL / circle ) II. Type of Building (check all that apply) N; R2t or 1 or 2 Family Dwelling — Number of Bedrooms bdivision Name CSM Number , � 1 n � ❑ Public /Commercial — Describe Use a ❑ State Owned — Desc Use ❑City ❑Vill e0Township of III. Type of Permit: (CILck only one box on line A. Complete line B if applicable) New System y 11 Treatment/I Iolding Tank Replace Only ❑Other Modification to Existing m y eplacement System B List Previous N o Permit umber and Date ued ❑ Permit Renewal ❑ Pe evisi n B. o ❑Change of ❑Permit nsfer to New Before Expiration Plumber Owner IV. Type of POWTS System: Check a at appl Non — Pressurized In- Ground ❑ Mound > 24 of suitable soil 11 Mound 4 in. of suitable so [I At-Grade El Single P r ❑ Constructed Wetland 11 Pressurized In- Ground old Tank ❑Peat ter r i Tr ent i� ❑ Reci lati ter El Recirculating Synthetic Media Filter Leaching Ch. ❑ Drip Li Grav ess P Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) isp rsal ea Required (sf) ispersal Area Propos Sy Eleva 7 15?�7f�:o VI. Tank Info Capacity in Total Number Manufacturer b Site S Fiber Plastic Gallons Gallons of Units C e Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treaunent Unit /no I Led' Dosing Chamber VII. Responsibility Statement- I, the undersigN responsibility for ins ation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum r' a Mpt S Number Business Phone Number Z Plumbers Address (Street, City, State, Zip C " VII Coun 1De art Use Onl Approved Disapproved �fbrDNenial Sanitary Permit Fee (includes Groundwater Date ssu d Issuin gent Sign a (1`I Stamps) Surcharge Fee) n Sao • od Q5 IX. Conditions i i LON for Disapproval n and a � e) be �� ae Der MwU pTan provided by olumber 2 AN aeiback requirements must be maintained so per applicable code / ordinances. Attach complete plans (to the County only) for the system on paper not less than SW x 11 inches in size SBD -6398 (R. 01/03) , t' a 'a► an 16FA N,«Alfto . . t as rs Ns0 tsrlmulq 0 bAtis tole mill tnemspsrnm tsq ss ty�n +s ±nas•� -rt +aur* �snent4 „upst �4?6�ls3 NA .S 4r.,, , A:ra^ i7ah I&A 313 oyl Q4 � g w 41 , a 0 COP J t � 0 a I Vl� i Directions: Place corresponding lateral diagram in the space provided on the sheet to the left. i P : f IE X ----> kE x12 ! x12 +I Laterals & force main of PVC Sch 40 (per CONIM7 Table 84.30 - 5) Holes drilled on the bottom of the: lateral, i = Turn -up wlbalivafve or aieanoutpiug equally spaced L Force main connection via rep or cross to manifold at any point. Laterals are identical I ft P •= Turn -up widball valve or Tjj< -x ----+ j+x12 I x12 +1 Laterals & force main of PVC Sch 40 cl ea n ou t p l u g I per l_ i=iMM Table 84.31 l -b Holes grilled or, the bottorn. of the lateral. f f Force main connection via tee or cross to manifold at any point. Laterals are identical All- S t P i = Turn -up vi' Ins ll +i8iir? ur or x{--�it-,d_2 1 ' x1241 Laterals & force main of PVC, Sch 41] cleenQutplug per C:OP.° IA Table 8430- Holes drilled on the bottom of the lateral. Force main connection via tee or cross to manifold at any point. Laterals are identical '1 c 1. P O = Tum -up w4h cieanraut plug or bail ualtre S d �F}r, -1 db Holes drilled on the bottom of the lateral. Laterals & force main of FvU -.oh Q as per Comm Table 84.30 -5, Ws. Adm. Code Laterals centered river the A ik R dirrlens;on �! = Turn -up frlbia ;halve or cleanoutplug f P i Last ho i1rilled ne=xt to end cap !- XX--- Laterals 3: force main of PVC Sch 40 Hole drilic - d on the bottom ®r the lateral tper C0rArv1 Ta I le Ald_;0 - 5'I equally spaced Center the laterals over the A u B dimension i= Turn -up wt ball waive ur cleanoutpiug P .I f I l•.l - t g.ste -r-�!� jrc i.?�.r.tio =3d ! < 7 "_—1 — d6lisd ._ n 11 E.otr._.rre ._.e tna ! 3tar i _ equally spaced b Laterals & ror.:;e main of iC ^ah 4.9 Fnrc =e m -yin ac.nnertgr_•n vi.3 rFe or Gros = - rn rnanirc.irS at anv point. I r V 3 h 1 5 �7 S'9 S ,S S'6 Y / �l �I CIO f Wisconsin Department of commerce SOIL EVALUATION REPORT Page - _ of 3 Division of Safe and Build s g in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. pending Please print all information. evi wed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Z S Property Owner Property Location Thomas O'Leary Govt. Lot NW 1/4NE 1/4 S18 T28 N R19 X (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 389 ay. M. "F" 8 1 na I Eng lish Estates City State Zip Code Phone Number ❑ City ❑ Village X] Town Nearest Road Hudson WI 1 54016 ( 715)381 -5590 Troy Encr lish Court ® New Construction Use: ® Residential / Number of bedrooms 4 Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material outwash Flood Plain elevation 1FaPPllcable /' pa �. ft• � w ` `,r jW 1 General comments and recommendations: ✓ . 7 /' �' ; , �trenches @ e . 9 ?, 0', spaced to codeC4.00')below de 4A n Boring ❑ Boring # ® pit Ground surface elev. X5,1 n ft. Depth to limiting factor 1 1 0 Z� 1 Soi[ lio6tion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bounda F4 GPD /ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 1 -6 10 3/3 non L 2csbk 2 -58 75.ry4/4 none cos os dl 3 8 -110 75. 4 6 none Boring # Boring 2 ® Pit Ground surface elev. 97.70 ft. Depth to limiting factor 11 0 in Soil � Ap plication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. r.5 f#1 'Eff#2 1 -6 10yr3/3 none L 2csbk dsh cs if .8 • (e 2 -10 10 5/4 none sil 2csbk dsh gw if A 3 0 -50 75.ry4/4 none cos osg ml Qw na 7 1 •� 4 50-110 7 I 'Effluent #1 = BOD > 30< 220 mg/L and TSS >30 < 150 mg /L eEvakfation ent #2 = BOD < 30 mg/L and TSS _ 30 mg/L CST Name (Please Print) Signature CST Number Gar L. Steel 02298 Address ate Co ducted Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 8 -30 -2001 715 - 246 -6200 Property Owner Thomas 0 r 1 "Ba-rY Parcel ID # bending Page 2 of 3 3] Boring# E] Boring Q pit Ground surface elev. 9 ft Depth to limiting factor 110 in Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 1 0 -6 10yr3/3 none L 2csbk dsh qw if .5 .8 •iP 2 6 -55 7.5yr4/4 none cos osq m1 na na 7 1.2 .� 3 55 -11 75.ry4/6 none ms Osg ml na na .7 1.2 .� F- Boring # F] Boring 4] 13 pit Ground surface elev. 93 71170 ft. Depth to limiting factor 110 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -8 10 3 3 cs if .5 .8 r (� 2 8 -60 7.5ry4/4 none cos Os ml •'�'- 3 60 -11 75. 4/6 none ms 0. F-1 Boring # r] 1:1 Pit Boring Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BOD 5 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. SBD -8330 (R6=) II a STEEL'S SOIL SERVICE Gary L. Steel Thomas pILeary 1554 200th Ave. CSTM2298 NWINE' S18- T28N -R19W New Richmond, WI 54017. MPRSW -3254 town of Troy (715)246 -6200 lot #8- English Estates 7his soil. evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shorn as permanent lot lines were not establidod, at the time the test was conducted. N 1 " =40' BM.= top of NE lot stake.@ el. 100.00' alt. BM.= base of wooden corner brace post @ el. 92.30' :LA Vic - 8 X 'A a 0 -& Gary L. Steel 8 -30 -2001 iAW 80. Fr. F & oo LOyr a LOT S \ � K `F wore: E.O4,/� \ \ Qd" d ND OW&4pe op ice' UM SQ. Fr. I D* OP0i MM C \ t S Puri FM t Ft F.FE — X31.61 •* \ WOMM W TO Ei ram i '� at�.a1' amar aro � o 13MM "W WMFA SOUMUNE CW "*NOM WFWOF7MPWWQFnV WAI tart Put OF OW 17 OUrUM I. ! i 41 �kk OURar 18 OEM TO M GMT. em DPANAGEARrA SOIL EVALUATION REPORT P4" ' 3. d am+ 1 wmcWW3& Ws. anft co c°"rr St. cvWx p� an paperadim ton In x 11 Mdm in shL Plan must `- -' Wd.W, bat rol ilmO d u va" Pea bmiaalW raferenoa Doaa }. dkectlon and t?aroal La Ps+ �entdaps. ecMaadbna. nahar. andmcsibne�ddictanoee�n�wstea3d. �vM� Dab Phase tmt an a'adoratblad". w I�It�)f� � csetaendHa.essenveut���+rreuwa las�a0a»iwl�A'dvaorr { PMPWy ] 1QaltS O' Govt. Lai NW - ig%R , V4 S1 a T N R 19 >E (old w p,pWWNWa Aa IT a 389 . RD." t'" llsh Iast3te5 Cade Phone Number ❑ City ililepe Tav" NeareW Rued wE I 84016 715 381 -5590 WD ® WawO Ubrx® gosaden�tlwn�otbedrmns a CadederMraadetr10ll1ba►� 600 . q Q Pubbm - 005CO& i Rventmel6lMi rrat} -w�ch ., t100d Fbail eaee fen it e110e _ -- (�6rag1 aananenU; anal . 97.70 tmrxhes 0 el. 99,70', sp®0ed to 0080 4.00' below grade a ° 1 a Pit t3round t�rtaae aler. 95.E fti Cape, b th+tlnn8 Tana 110 3n Rds 7 58 + Lea imt Rodoa 0eaal m Teaeae SWUCWm Cans�temm b'laaMary Roots OL Mu rad CAL Ss. Curt C W 1 3/3 none 2 75. 4/4 none Cos 3 5& 110 75.ML4 6 « 13 � rrra swta,galov_ 97.70 R Depth b a9 teals 110 In. Rsl! Noriaon Papth Dmidont Reds[ Dasort gm Te�atg Sanrlure � Rants SA WL muWR s ML SL Goth. Cow tar. 6s. 8h. 'C�Mt 'E1lZ 1 103 L 2csbk db3h ca If .5 8 2 10 1 /4 tmtoe 1 3 0-50 75.xy4/4 none Cos teal gy ma 7 4 S&130 7-indlfi ago- • tit M = 80D s 30^ 2W ]V401 NO TSS 130 c 150 e4l6 Q = f�U < mplL a+d T5S 90 - CST tiraibar F Nsn• t "" s 02298 aar L. teal fetepnona 200th. Ave., Now RiCb Md, Wl. 54017 8-30 -2001 715- 246 -8200 � Il.i is - � __ r •' 1 • �• ■ mom -mmm Ila / IFS la "• -1. - �_ 1 n STEEL'S SOIL SERVICE Mary b. Steel u mu O'Leary 1554 200th Ave. 'L,STM2= mint S18 -no-am New Richmond. W 54017. MPRSW -3254 tom of Tty.. (715) 246 -62M lot O- English Estates U" mail mmzmtfi p} t to smtIWF a ScId r6Wdz r W*, it MY cc mv amt Ua evitataa ftlr y=w VM "W 10m use of tape twt NW or •wtar amt be ".*Ama i* PMrA=Mt I t tiffs IMM ,tot O§tMb dOd at ttw Lire tb* tent maw CWWftCtad. N Nr BM.= top .of 1E lot stake -@' el. 100.00' . alt. Bm. = >aise of wooden earner bmce post @ el. 92.30' • - :.. Sys •- 1 �, - • . - . a��... -..� e .g. - • . t a ar Gary 30..E � * 1 da ** of * A. * _ 66 it s � to •� i` \I ILI \, * * ���,�����,`����� fie♦ .. w♦ �♦ s o VI ' 7 661879 Document Number WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS ST_ CROIX CO., WI This Deed, made between THOMAS J O'LEARY KATHLEEN E RECEIVED FOR RECORD O'LEARY SA . husband and wife Grantor, 11 -12 -2001 3:30 GM , AND KERNON J BAST and DONALD0 SPEER -BAST WARRANTY DEED XEMPT N CERT COPY FEE: COPY FEE: husband and wife, as survivorship marital property Grantee, TRANSFER FEE: 1384.20 RECORDING FEE: 11.00 Witnesseth, That the said Grantor, for a valuable consideration of one PAGES: 1 dollar and other valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin: Recording Area This is homestead property. Name and Return, Address Together with all and singular the hereditaments and appurtenances thereunto belonging; And Grantor warrants that the title is good, Edlna Realty Title indefeasible in fee simple and free and clear of all encumbrances except) 400 S. 2nd St., #115 easements, covenants, and restrictions of record, C/ Hudson, WI 54015 and will warrant and defend the same. 3.�O39S" NORTH 935 FEET OF THE NW 1/4 OF THE NE 1/4 OF SECTION 18 (parcel Identification Number) TOWNSHIP 28 NORTH, RANGE 19 WEST, ST. CROIX COUNTY, 040 - 1071 -30 -000 WISCONSIN ted this$ da f /L/V V 200 7 THOMAS O'CEARY4 e - IZATHLEEN E O'LEARY AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN COUNTY OF ST. CROIX / Personally came before me this g4day of Ala • 2001 authenticated this _ day of the above named THOMAS J O'L KATHLEEN E O'LEARY ' O> to me known to be the person(s) wbo ~ orng signature instrument an n wledge the W type or print name �' ~ signature TITLE: MEMBER STATE BAR OF WISCONSIN type or print name (If not, authorized by §706.06, Wis. Stats.) Notary Public ST. CROIX " A rsyTA'tE My commission is permanent. (If not, s{Atet'expiration date: THIS INSTRUMENT WAS DRAFTED BY •) Robert F. Wall •Names of persons signing in any capacity should be typed or printed below their signatures. fir. Lt000 1rJ:i1rJ r17.:irr�v�o a•..i�,,�� •.••�••_•,.�..... - - ._ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer E AST - Mailing Address 149 44 BReck 90 s NUO5a.3 , wr 5'(01�O Property Address L01' 9 EAwUSl+ ESTATES ' -34$ !<it)bcIS* COUKE ( verificat io n r uired from pl ann i ng D for new construction) t 8 P C ity / / rate N vo5aa iwstxwsfAl Parcel Identification Number — - LF &AL DESCRiP330I4 Property Location AlW 'A, NE ' /., Sec. _1E T .28 N -R l4 W, Town of TROY Subdivision 6%JGUStt esTfts . Lot # S Certified Survey Map # , Volume , Page # Warranty Deed # , Volume , Page p Spce house A ycs O no Lot lines identifiable yes ❑ no SYSTEM MAINTENANCF, Improper true attJ maintenance of four septic system could result in i t s premature failure to handle wastes. Proper matnrcnancc consists of putttptng out the septic tank every three years or sooner, if needed by a licensed pumper Wttat you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to subnut to St. Croix Zoning Department a certification form, signed by the owner and by s MMIC., plumber, journeyman plumber, tcstrictcd plumber or a licensed pamper verifying that (1) the on -site wastewaterdisposat sysicM is in proper operating condition andror 12) aftcr imcclm and pumping (if necessary). the septic tank is less than lf3 full of sludge. Iiwe. the derst ed have read the above requirements and agree to maintain the private sewage disposal system with the standards set f here , as set by the Department of Commerce and the Department of Natural Resources, state of Wisconsin Certification s t hat ur It , 'tern has been n.aintct,nrd must be completed and rctumcd to the St. Croix County Zoning Offtcc within 30 c sys or a ye cxptr iun date. NA F JIPPLICANT DATE OW C , TIFICATION 1 ( tent£ that all statements on this form arc true to the best of my (our) knowledge I (we) am (ate) the owners) of PC nbc abov , b . of a % % arranty deed recorded in Register of Deeds Office. g ATU 7nmaiio PPLICANT DATE ••••'• Any I that is mts represented ntay result to the sanitary permit being revoked by the Zoning Department. •• Include •vilh tttis application: a staa+pcd warrowty deed front the Register of Deeds office ti copy of the certtGtd survey map if reference is made in the warranty dtxd z'd EBBL98ESTL uosuyor uoser d11 :10 EO 8i: 400 POWTS OWNER'S MANUAL & MANAGEMENT PLAN, Page — / -- of —.2 FILE INFORMATION,/ SYSTEM SPECIFICATIONS Owner S Capacity al O Ni, Permit # k Manufacturer. , . S' ❑ N DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units NA Pump Tank Capacity 0 NH Estimated flow (average) Pump Tank Manufacturer - 0 N� Q al /da Design flow (peak), (Estimated x 1.5) al /da Pump Manufacturer N Soil Application Rate al /da /ft2 Pump Model 1�NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit It NH. Fats, Oil & Grease (FOG) 530 mg /L O Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L 0 NA ❑ Mechanical Aeration Q Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection CI Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ N�, I Biochemical Oxygen Demand (BOD 530 mg /L in- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L fZ NA ❑ At -Grade © Mound Fecal Coliform (geometric mean) S10' cfult00rnl ❑Drip-Lino Q Othor, Maximum Effluent Particle Size Y in dia, O NA Other: ❑ NA Other: ❑ NA Other: ❑ NA I * Values typical for domestic wastewater and septic tank effluent. Other. ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency ❑ month(s) (Ma4m4m 3 years) ❑ NA Inspect condition of tank(s) At least once every: earls) Pump out contents of tank(s) When combined sludge and scum equals one -third .(Y of tank volume ❑ NA 13 month(sl (Maximum 3 years) ❑ NA Inspect dispersal cell(s) At least once every: year(s) ❑ month(s) O Ni.. ^ I Clean effluent filter At least once every: �, _P�year(s) ❑ month(s) AD NF- Inspect pump, pump controls & alarm At least once every: p y ear(s) Q month(s) t Nk Flush laterals and pressure test At least once every: O year(s) other: O month(s) Q'NA At least once every: Q year(a) Other: (DNA 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 thu 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. ' a't, 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. ()MW I4/0 1 i k ). Paglk--Z 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 chomit;als 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 orsurfeoe 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 ;; -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 systern 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 foaled,, r, • 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 rnust comply with the rules in effect at that time. 0 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.—- Q 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. 0 Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time, < < WARNING > > 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 INSTALLER/ POWTS MAINTAINER . I Name Name Phone Phone I, SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATO Y AUTHORITY Name Name A Phone Phone ;f ' his document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 93.64(1), (2) & (3), Wisconsin Administrative Code, ' 2000 Oxford Avenue (715) 552 -8888 Eau Claire, WI 54703 Fax (715) 552 -8827 1- 888 - 844 -1980 PREFERRED PUMP 7- /4-0 �o 9 , 7 , 7 K 9s �i� Rl /Z)a .B -�- ��� 7 __ ,. s� i� iii - �� - �� � �� 73.E + i N OWNOIt -, COUNTY PLAT OF: _ LOQ"T GXKFC" ENGLISH ESTATES p , mwni,r�rwT .►- ° Y r ` LOCATED IN PART OF THE NW1 /4 OF THE NEII/4 OF SECTION 18, T28N, R18W, I suwYerow TOWN OF TROY, ST. CRODC COUNTY, WISCONSIN. 3 S� mrenrr ■€� I l = NweTN4,� / � I I 1 OIL m I La" I URN r I — PIL I Yr3.2li!R!! r 77►t7+r7s I ta7,.t� 1 wn..a �• _ _ rrw•rrw ° rw ! s -43 I \ I I I 1 / / 1 aolafa IN r7er 1• a ,0? ^ \ \\ 1077 li j lOf4 ( f LOf7 / / /// 9� , ,M rN i n. I j I Yar f !!! I / / LaOY.D I mwn�.w.m..� � R � Lar, • rr.wRawr.r � rr pp rr i rrarrrt. 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