Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
040-1106-50-025
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 574335 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: Hieb, Matthew& Bridget I Troy, Town of 040-1106-50-025 CST BM Elev: .� nsp.BM ev: BM Description: Section/Town/Range/Map No: !� rz P 27.28.19.423A05 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic � T Benchmark 2 �/ l/ t Dosing Alt. BM Aeration Bldg.Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic� � � - /� Dt Bottom Dosing �J Header/%= S 1W-01 Z •�-p Aeration Dis. Pie q.�►� /' Holding Bot. System *1-z Fin ra e PUMP/SIPHON INFORMATION +R/— ,,.�.Manufacturer Demand St Cover GPM ""� Model Number TDH Lift Friction Los Sys Head T DH Ft Forcemain Length Dia. Dist.to II SOIL ABSORPTION SYSTEM �' (rn BEDITRENCH Width I I Lengt No.Of Trench PIT DIME S No.Of Pits In ia. Liquid Deir DIMENSIONS -3-- SETBACK SYSTEM TO P/L BLDG WELL LAKE/STRE LEACHING Ma�fa� Z;� J INFORMATION CHA Ty Of System: 15-, ) / UNIT Model Number: (M DISTRIBUTION SYSTEM Header/ anifold Distribution f JeT x Hole Size x Hole Spacing Vent to Air Intake a Pipe(s) Length r 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 Bedfrrench Edges Topsoil i l i Yes [ No I' ' Yes::N,] COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: Inspection#2: / / Location: 178 Bjerstedt Lane River Falls,WI 54022(SE 1/4 NW 1/4 27 T28N R19W) metes&bounds Lotr�Q Parcel No: 27.28.19.423A05 1.)Alt BM Description 2.)Bldg sewer length � �y� C1 �p/y -amount of cover T L Plan revision Required? � -�, Yes L_i o _ � i '/ �' I r [ �< n _ Use other side for additional information. �;te/ SBD-13710(R.3/97) Date Insepctor's Signat re Cert.No. ST. CR .I1T Y Land Use Planning&Land Information Resource Management Community Development Department Thursday, August 14, 2014 Matthew& Bridget Hieb 178 Bjerstedt Lane River Falls, WI 54022 Regarding septic inspection for Matthew& Bridget Hieb. Location of Property in St. Croix County: Municipality: Troy, Town of Subdivision or Plat: metes & bounds Certified Survey Map: Vol. 08 Pg. 2180 Lot: Address: 178 Bjerstedt Lane Dear Applicant: A septic inspection of the above reference property was conducted on August 14,2014. This property is located in the SE 1/4 NW 1/4 of Section 27, T28N R19W, metes & bounds Vol. 08 Pg. 2180 (Lot ), Troy, Town of, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a 3 bedroom home. Additional Notes: Adding 900 sq. ft. in 2 cells of 9 EZ Flow units each to existing 4 BR POWTS due to gopher damage. Total dispersal area will meet 4 BR sizing. Connection to existing forcemain at header. If you have any questions regarding this, please contact our office at 715.386.4680. ly, Pam Quinn Zoning Specialist cc: file Phone 715.386.4680 Government Center, 1101 Carmichael Road, Hudson, W154016 Fax 715.386.4686 www.sccwi.us/cdd www.facebook.com/stcroixcountywi cdd@co.saint-croix.wi.us o _ o S .t, x p p 04 d 2 co 0 co CN CO 04 v r°4 c) CO C C C OI C 9 e Z a�at a•°i m J ,",� , J c c o e p t„ N a) 4J 1-. 4 ` �` ��.• o o w WwILa` �l 01 m ca �n m iD o ip o 1 o y V) O OD t0 M r � n 1 CD , czeo o d 41 .., N c d m C13 ui k N m 0 t ate. a c 0 cc co Y C N d ~ O — A 0 fn O CL O � Q Z \ M r 0 V �� r ± wawa ° mzf- cn g E c C 9 E ai 2 � cuC o .> > > z caM m ww = Cf) 22 o mmm ( '�` IL P1 !�! . -p- County j Safety and Buildings Division j 7. �$ �� 201 W.Washington Ave.,P.O.Box 7162 Sanitary Permit Number(to be filled in by Co.) ' Madison,W 1 53707-7162 3 nn itary Permit Application State Transaction N n In accordance with SP-b`383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit ,4 is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(i different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary s in accordance with the Privacy Law,s.15.04(1)(m,Stats. I. Application Information-Please Print All Information 5 yvi C- Property (- Property Owner's Name Parcel# ATTFfEk) ri-yule QkiOG��T 0 0- /l0(, — Property Owner's Mailing Address l Property Location / 7 e 8 It?57--,'—IJ l L/4A,/t Govt.Lot J City,State Zip Code Phone Number Z 0 N; REo� T II.Type of Building(check all that apply) Lot# (�I Xmrnerci2-ily Dwelling-N of Bedrooms Subdivision Name Block#P Describe Use ❑City of ❑State Owned-Describe Use CSM Number ❑Villagpof own of T III.Type of Permit: (Check on ..one n line A. Complete line B if applicable) S- ` , ❑New System �R stem ❑Treatment/Holding Tank Replacement Only Modification to Existing ( n) 3 1 TL ' B. ❑Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Previo p ermit Number and Date Issued Before Expiration Owner -/t9 7 IV.Type of POWTS System/Component/Device: Check all that apply) Non-Pressurized�Zer El Pressurized In Ground t ❑Mound in.of suitable soil ❑Mound<24 in.of suitable soil ❑Holding Tank ispersal Component(explain) s❑ etr ice(explain) V.Dis ersaVrreatment Area Information: Design Flow(gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required(sf) Dispersal Area Proposed(sf) System Elevation '1 -D 1 01 S ✓ I z90 Q 9•O0 ✓ 97 35', 97/0 VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units o u o New Tanks Existing Tanks e ° Y aU rn m wt7 a Septic or Holding Tank >Z-©Q /Z OQ /,r 5 L Dosing Chamber ®C Vo o / /C Ie VII.Responsibility Statement-I,the undersigned,assume responsibility for Instanation of the POWTS shown on the attached pleas. Plumber's Name(Print) Pl n e MP/MPRS Number Business Phone Number J ot�ry �c�+wi rr r Zz3 7(� 0 71s-7� 0- 0 1/9� Plumber's Address(Street,City,State,Zip Code) VIII oun /De artment Use Only Permit Fee Date, swing Agent Sigoature,, < pproved ❑Disapproved $ _�ri7 --7 L 1 ❑Owner Given Reason for Denial TX.Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: u ` / _/ ✓ V 1.Septic tank,effluent filter and f 7 dispersal cell must serviced!maintained � as per management plan provided by plumber. GlJ 2.All setback requirements must be maintained . 0 Z f as per app ice for the system and sn t to th-etimity�o*an vaner not Ins d=#1/2 xA SBD-6398(R. 11/11) CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Hieb 3 Bedroom Septic System Owners Name: Matthew& Bridget Hieb Owner's Address 178 Bjerstedt Lane River Falls, WI 54022 Legal Description: SE1/4, NW1/4, S27, T28N, R19W Township Troy County: St. Croix Subdivision Name: Lot Number: Block Number Parcel I.D. Number 040-1106-50-025 Plan Transaction No. Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing &Cross Section Page 4 Septic& Dose Tank Specification; Page 5 Effluent Filter Information Page 6 &7 Management and contingency plan Page 8 Septic Tank Maintenance Agreement Page 9 Dose Tank Cross Section Page 10 Pump Information &Curve Page 11 EZ Flow Information Page 12 Warranty Deed Page 13 CSM Page 13-15 Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date: 8/6/2014 Phone Number: 715-760-0486 Signature: In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P(N. 01/01) I Oa- p $ coC) � w o m 0 2 Q 0 o L (q cam) 'I)c c r)' V V 04 � tit 1 O C O O 2 N O O 1- © \ o ca to w wwa` a` o a OR 4q Cl ` y cn � � 1 � C 4Z m ° Q � C%lM CD ++ p xc N c Y � l N O CO p O. 06 a w E � m a 0 � Y G z H N m ~ O - N fn O S1J CL O SL1 X_ ~ � 41 N tz-c d H 1L Q m to 7 O z C O U) C C �Js Qj tVO O O O O gym„ E ~ > > a. Z m a m N CD W W U N N Y N cn 2 m •o mmm CL d ■ tu SOIL ABSORPTION SYSTEM DETAIL/GRAVELLESS LEACHING UNIT Project Name: Matthew& Bridget Hieb 2 No.of Cells 9 Per Cell 3 ft Cell Width 18 Total No of 1203H 90 ft Cell Length 450 sq ft EISA Per Cell 3 ft Cell Spacing 900 sq It Total EISA Manufacturer Model Laying Length EISA Rating Infiltrator EZ1203H-5ft 5.0' 25.0 EZ1203H-10ft 10.0, 50.0 Gravelless Leaching Unit Manufacturer: to Infiltator Gravelless Leaching Unit Model: 1203H Typical Cross Section Finished Grade 99 ft Observation Pipe with approved cap or vent ,♦♦rr■r.■.■r■■•�.♦••.♦r■�.r■. ■■.■.■ .=r■r■■■■rr■■rrrr■r■■rr■r■■■■rr■ ♦♦■■rr■■■ ■ Soil Backfill 20 in ' ■ Geotextile Fabric 97.35 97.10 ft Infiltrative Surface 12 in 0 I I 94.1 ft Limiting Factor 36 in Slotted and Anchored Vent/ Observation Pipe with Cap ■■rr■■■■■r■■■■■■r♦■■■■r rri■r■■■■r sr■■■■■■■■■■r■■■■■r■r■r■■■r■rr■■■■■r■■■■■ Plumber/Designer Signature: License#: MPRS 223760 Date: August 6, 2014 Wisconsin Department of Commerce,Safety and Buildings Division, 5. The Absorption area (SF) necessary for a given site shall be has reviewed the specifications and/or plans for this product and sized based on maximum daily sewage flow(GPD)and the determined it to be in compliance with chapters Comm 82 through Permeability for the site. If certain criteria is met, the EISA 84,Wisconsin Admin.Code,and Chapters 145 and 160,Wisconsin sizing can be used in Wisconsin, resulting in a 40%smaller Statutes. All sites must meet the Site&Soil Conditions&Locations &Isolation distances as noted in local regulations. drainfield. The approved products are 1203H(3-12"bundles with pipe in cen- 6. Place EZflow bundle(s)in the EZflow configuration approved ter bundle in 5'or 10'lengths)and 1203HP(3-12"bundles with pipe by system design permit specified for the particular site.The in each bundle in 5'or 10'lengths. top or center-most bundles containing pipe are joined end to A single pipe bundle contains a four inch perforated pipe surround- end with an internal pipe coupler.Any additional aggregate ed by EPS aggregate and is held together with polyehtylene net- only bundles that may be required,should be butted against ting.A single aggregate bundle contains aggregate only and is held the other aggregate-only bundles and do not require any together with polyethylene netting, type of connection. Materials and Equipment Needed 7. The top of each GEO cylinder contains a filter fabric pre-manu- • Wow@ Bundles factured in between the netting and aggregate. The fabric • EZflow Geotextile Fabric is inserted to prevent soil intrusion. The installer shall make • EZflow Internal Pipe Couplers sure the the GEO is positioned upward and is in contact with • Pipe for Header and Inlet the fabric contained in the adjacent cylinder before backfill- • Backhoe/Excavator ing. Installation instructions 8. The EZflow Drainfield Systems should be installed in a level The instructions for installation of EZflow•products are given be- trench in all directions (both across and along the trench low. This product must be installed in accordance with state rules bottom)and should follow the contour of the ground surface defined in chapters Comm 82 through 84,Wisconsin Administrative elevation (uniform depth), with all continuous adjoining Code,and Chapters 145 and 160,Wisconsin Statutes,as well as the 10-foot cylindrical bundles placed end to end, with central local health department's current design manual. bundle distribution pipe interconnected,without any dams, stepdowns or other water stops. 1. After the local health department has determined sizing,con- figuration,and layout for the Wow systems,stake or mark 9.The trench top shall be graded such that water will not pond. with paint the location of trenches and lines.Be careful to set Backfill should be seeded or sodded immediately after correct tank,invert pipe,header line or distribution box and completion to reduce erosion. trench bottom elevations before installation of pipe bundles. 10.EZflow EPS bundles are flexible and can fit in curved trenches 2. Remove plastic EZflow shipping bags prior to placing bundles as may be necessary to avoid trees, boulders, or other in the trench(es). Remove any plastic bags in the trench be- obstacles. fore system is covered. 11. EPS aggregate is lighter than water, therefore, it might be 3. This product must have geotextile fabric that meets require- expected that natural buoyancy forces would tend to cause ments of s. Comm 84.30 (6) (g), Wis. Adm. Code, installed EZJZow assemblies to float out of ground when ponding oc- directly on top of the product and extending down along the curs. Field experience has shown,however,that this is not a sides of the product to a point at least six inches from the problem when systems have a minimum of 6"of soil cover as bottom of product. recommended by manufacturer. 4. When installed in a trench, the trench should be dug to a 1203H-GEO width of 36 inches. This not only saves labor in excavation, Geotextile but also provides better load-bearing capacity after backfill- Barrier Material ing is complete. 12• Ur x>a CPN Ifa eury cuss w rM PJ1QfNN. P�LCOI1fl1N(: Tap Vew EZflow Ring Industrial Group P: 1-800-649-0253 30 Industrial Park PERFORMANCE. QQ DOES IT.. F: 1-866-279-9203 Oakland,TN 38060 Ringlndustrial.com 1044-101008 0 2006 Ring Industrial Group,LP D Z X 53" AS 96" 41" REOD � z z m c D Li 0 m� v o UP 40" >� 4" CAS N 3" 44" 6" ,i F I m D� m �1 D Ri 36" 8 0 m D 1 rn N I N I ,Q ["UP 38" m Z 4" CAS , a � 0 4' O f+I D 39" F m cn D I U) A Vn > r r Z Z D v --q C DO Z Z O D r r O D D �Z t7 ^O�D 47�D r�fperm*1��*tr=*iDOcC ODN r �N Xr � Z Zvrr-tx/1 D -INVD v 0000�OZr1r �rrZ (�0 O X U) m m O 2 c� A =p mc x ;D O rn c� �m m`m = rn D �zOmDO i�� .w N n v1 Fri 2 V 2N nmN r � z �Z n1 OOr�r*iOo,Zj,, c s mQ �fX/1 NCO D W NW �N"iNID S �O s- C7� ao a o D =n D o N gi.pp+ trot rrn D I w t°o b-� ?1 OD LI)n < m °° W f7 DO Z�rn z Z DD MMITI mpD OON D Q 0 QL F� n 0 y rr =r=D r0 �g n m < v m H D mm Z ZZ z"kv CD �� N Q .. .. .. Z 0 my D .... 4021 07D N -- Z TI .�.. z c m cN r �m 0 V) O 0 �� O 3 U) O m (a v�Ai r 0 D - �o m F m O O g H Z m .. M r, m 0 W1200/800-MR DRAWN BY: SME SCALE: 1 4'=1'-0" RE-POUR: MHER 1111RETE REV. ° -4 SEPTIC MANUAL DATE: JANUARY 2010 DATE.. OST-POUR: \Z W3716 US HWY 10 MAIDEN ROCK, NA 54750 O REVISED JAN. 2010 800-325-8456 InLF-: WMNO innovadonsinPrsw—OraM�e Zabel' PL-525 Effluent Filter &Wastewater Products A Division d Pdybk Inc. PL-525 Filter The PL-525 Filter is rated for 10,000 GPD(gallons per day)making it one of the largest filters in its class.It has 525 linear feet of 1/16"filtration slots.Like the Polylok PL-122,the Polylok PL-525 has an automatic shut-off ball installed with every filter.When the filter is removed for cleaning,the ball will float up and temporarily shut off the system so the effluent wont leave the tank. Features: 06" Filtration Slots • Rated for 10,000 GPD(gallons per day). Alarm Switch • 525 linear feet of 1/16"filtration. 10,000 GPD (Optional Accepts 1"PVC • Accepts 4"and 6"SCHD 40 pipe. ! Extension Handle • Built in gas deflector. • Automatic shut-off ball when filter is removed. • Alarm accessibility. hated for 10,000 GPD • Accepts PVC extension handle. PL-515 Installation: i Ideal for residential and commercial waste flows up to 525 Linear Ft. of 1/16„ 10,000 gallons per day(GPD). Filtration Slots 1.Locate the outlet of the septic tank. 2.Remove the tank cover and pump tank if necessary. 3.Glue the filter housing o the 4"or 6"outlet t If Accepts 4"&6" g pipe. SCHD 40 pipe the filter is not centered under the access opening use a Polylok Extend&Lok or piece of pipe to center filter. err 4.Insert the PL-525 filter into its housing. r••� -- Certified to 5.Replace and secure the septic tank cover. NSFlANSI standard 46 PL-525 Maintenance: :. The PL-525 Effluent Filters will operate efficiently for � ,,,� several years under normal conditions before requiring cleaning.It is recommended that the filter be cleaned every time the tank is pumped,or at least every three years.If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter g Gas Deflector needs servicing.Servicing should be done by a certified septic tank pumper or installer. Automatic Ball L Locate the outlet of the septic tank. Shut-Off 2.Remove tank cover and pump tank if necessary. 3.Do not use plumbing when filter is removed. 4.Pull PL-525 cartridge out of the housing. 5. Hose off filter over the septic tank. Make sure all solids fall back into septic tank. 6.Insert the filter cartridge back into the housing making sure the filter is properly aligned and completely inserted. Polylok,Zr el&Best alarm. Extend&Lolls Polylok,Zabel&Best filters accept Easily installs 7.Replace and secure septic tank cover. the SmartFilter@ switch and alarm. into existing tanks. Polylok,Inc. 3 Fairfield Blvd. Wallingford,Cr 06492 Toll Free:877.765.9565 Fax:203.284.8514 www.polylok.com POWTS OWNER'S MANUAL & MANAGEMENT PLAN page—of FILE INFORMATION SYSTEM SPECIFICATIONS Owner: Matthew&Bridget Hieb Tank Manufacturer: Wieser Concrete r NA Permit# El Septic E Dose 1=Holding Volume: 1200 gal DESIGN PARAMETERS Tank Manufacturer: Wieser Concrete r NA Number of Bedrooms: 3 r Septic E Dose !�Holding Volume: 800 gal Number of Public Facility Units: W A Vertical Distance Tank Bottom(s)to Service Pad: ft Estimated (average)Flow: 300 gal/day Horizontal Distance Tank(s)to Serivice Pad: ft Design(peak) Flow=estimated x 1.5: 450_ gal/day Specific servicing mechanics must be provide if vertical is>15 feet or if In Situ Soil Application Rate:_0.5_ gal/day/ft2 horizontal is>150 feet.Specific instructions to be provided on back. Standard Domestic Influent/Effluent Monthly average Effluent Filter Manufacturer: Polylok r NA Fats,Oils&Grease(FOG) 530 mg/L Effluent Filter Model: 525 Biochemical Oxygen Demand(BOD5) :5220mg/L r_ NA Pump Manufacturer: Goulds r NA Total Suspended Solids(TSS) 5150mg/L Pump Model: EP04 High Strength Influent/Effluent Monthly average Petreatment Unit Fats,Oils&Grease(FOG) :530 mg/L Manufacturer: Biochemical Oxygen Demand(BOD5) 5220mg/L W NA ' Mechanical Aeration r Peat Filter FV NA Total Suspended Solids(TSS) :5150mg/L r Disinfection r Wetland Petreated Effluent Monthly average f Sand/Gravel Filter f Other. Biochemical Oxygen Demand(BOD5) 530mg/L Soil Absorption System Total Suspended Solids(TSS) :530mg/L #NA lip' In-Ground(gravity) r in-Ground(pressure) r NA Fecal Coliform eometric 5104cfu/100m1 f At-Grade r Mound (9 mean) Maximum Effluent Particle Size: %s in dial. i�NA r Drip-Line r Other: Other: r Other: r NA MAINTENANCE SCHEDULE Service Event Service Frequency When combined with sludge and scum equals one-third('/3)of tank volume Pump out contents of tank(s) When the high water alarm is activated (s) Inspect condition of tank(s) At least once every: 3 IV year(s) Maximum 3 ears r NA morm(s) Inspect dispersal cell(s) At least once every: 1.1 Id yer(s) Maximum 3 ears r NA r r (s) Clean effluent filter At least once every: 1.1 [P y-r(s) r NA month(:) Inspect pump, pump controls&alarm At least once every: 1.1 I'✓ y—(s) r NA At least once every: r yes) r NA r mon+(s) Other: At least once every: r yWs) r NA monthm Other: At least once every: r yearm r 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 Insepector;POWTS Maintainer;Septage Servicing Operator(pumper).Tank inspections must include a visual inspeciton 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 a check for any back up or ponding of effluent on 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 indicated a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumualtion of sludge and scum in any treatment tank equals one-third('/)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 Admininistrative Code. All other services, including but not limited to the servicing of effluent filters,mechanical or pressurized components,petreatment units, and any servicing at intervals of<_12 months,shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. (Rev.2/05) 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,solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil 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 extended 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 and may overload them resulting 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)discharge;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,pits and other soil absorption systems 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 the opportunity to obtain a sanitary permit for a code compliant replacement system: - )7 2.nt are as been evaluated nd�utied for the location of a replacement soil absorption system. e rom 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 the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations.If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology,a holding tank may be installed as a last resort. ® 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 time. WARNING: TREATMENT TANKS AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES AND LACK SUFFICIENT OXYGEN TO SUPPORT LIFE.NEVER ENTER A TREATMENT TANK OR HOLDING TANK UNDER ANY CIRCUMSTANCE.DEATH MAY RESULT.ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK IS VERY DIFFICULT. ADDITIONAL INFORMATION: POWTS INSTALLER POWTS MAINTAINER Name:John Schmitt Name:John Schmitt Phone:715-760-0486 Phone:715-760-0486 SEPTAGE SERVICING OPERATOR(PUMPER) LOCAL REGULATORY AUTHORITY Name: Owners Choice Name:St Croix County Zoning Phone: Phase:715-386-4680 This document is intended to meet minimum requirements of Ch.Comm 83.22(2)(b)(1)(d)&(f)and 83.54(1),(2)&(3),Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. (Rev.2/05) ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Matthew & Bridget Hieb Mailing Address 178 Bjerstedt Lane, River Falls, WI 54022 Property Address 178 Bjerstedt Lane (Verification required from Planning&Zoning Department for new construction.) City/State River Falls, Wl Parcel Identification Number 40'1106-50-025 LEGAL DESCRIPTION Property Location SE '/4, NW '/4 , Sec. 27 , T 28N R 19 W,Town of Troy Subdivision Plat: , Lot# 1 Certified Survey Map# ,Volume 8 ,Page# 2180 Warranty Deed# (0 2 (before 2007)Volume ,Page# Spec house Clyes[no Lot lines identifiable Oyes[]no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner,if needed,by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in§SPS.383.52(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,signed by the owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on-site wastewater disposal system is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is less than 1/3 full of sludge. I/we,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth,herein,as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St.Croix County Planning&Zoning Department within 30 days of the three year expiration date. Uwe 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 bedrooms 3 `( 7 /30/14 SIG ATU O APPLICANTS) 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.04/12) Parcel #: 040 - 1106 -50 -025 04/10/2008 09:28 AM PAGE 1 OF 1 Alt. Parcel #: 27.28.19.423A -05 040 - TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 06/20/2007 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - HIEB, MATTHEW & BRIDGET J MATTHEW & BRIDGET J HIEB 1271 140TH ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE SEC 27 T28N R19W PT SE NW COM W 1/4 COR Block/Condo Bldg: SEC 27: TH N89' E 2389.41 FT; TH N01' E 1001.45 FT; TH N89' E 229.13 FT TO POB; Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) TH N00' E 318.15 FT; TH S89' W 892.76 27- 28N -19W SE NW FT; TH S00' E 309.85 FT; TH ALNG ARC OF CURVE WHOSE CHORD BEARS N89' E 0.57 FT more Notes: Parcel History: Date Doc # Vol /Page Type 06/20/2007 853662 WD 05/01/2006 824048 EZ -CN 06/16/2005 797839 2824/165 WD 11/12/1997 568399 1276/329 WD more... 2008 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/24/2007 Description Class Acres Land Improve Total State Reason Totals for 2008: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Department of Commerce Count Safety and 136ildinrg Division PRIVATE SEWAGE SYSTEM St. Croix INSPECTION REPORT Sanitary Permit No: • 499291 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: 0 Valley Land Company Troy, Town of 040- 1106 -50 -00 CST BM Elev: Insp. BM Elev: Description: Section/Town /Range /Map No: ( 00.6 BM (� 27.28.19.423A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic /ZOO Benchmark - T / O -7_� �� Dosing v Alt. BM I:, yr 101.3s-- Aeration � I I , /_ Bldg. Sewer / �? 0 e l7. 0 Holding —s 5 St/Ht InIG /O . D �X TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet s Septic � 2 � / � � Dt Bottom � 3 . / � • .� Dosing !!de Man. �c-] /� ,G� o O C l� Aeration - -- /Q- Dist. Pipe Za Holding B ot. System g S v Final Grade PUMP /SIPHON INFORMATION atv - 74 /00. Manufacturer Demand SLIZIlayeL GPM Z 6 vl Model Number � / / / 14Z TDH Lit Friction Los System Head Tr —'/ Ft Forcemain Lelg� Dia.„ Dist. to Well �f j SOIL ABSORPTION SYSTEM -0 movw7zi7 -C..o� BED /TRENCH Width / Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 / 2 SETBACK SYSTEM TO P/L BLD IWELL LAKE /STREA LEACHIN Manufactur INFORMATION f System: / CHAMB T R Type PIST\R IBUTION SYSTEM B anifold Distribution x Hole Size x Hole Spacing Ven Air Intake f Pipe(s) � L _ / �— G �j - V Length Dia LD ia Spacing �J L SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only > 7,d 1, Depth Over / // Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Tren h Ce{�ter ' � Bed/Trench Edges Topsoil Yes No Yes No JjAad ja t - " ti "4.( COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1:/ / Inspection #2: Location: 178 Bjerstedt Lande Hudson, WI 54016 (SE 1/4 NW 1/4 27 T28N R19W) NA Lot 1 _?Q Parcel No: 27.28.19.423A -� �7 Ss 9 1.) Alt BM Description ption = � U ���'�' 2.) Bldg sewer length = / �� 3y Z / 3 adph - amount of cover = Plan revision Required? Yes , No Use other side for additional information. Date Insepctor's Sig ture Cert. No. SBD -6710 (R.3/97) I _ Safety and Buildings 1, 11 County f AN AN 201 W. Washington Ave. O. 62 iscansin Madison, W .� I 53707 162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce ( 266 -3131 Sanitary Permit Appl' p tare Plan I.D. / N�um ) ber In accord with Comm 83.21, Wis. Adm. Ctx1e, personal nfarm7[IO�jOywMED N* may be used for secondary purposes Privacy La v, s15.04(1)(m) Project Address (if di ff nt than mailing dress) f I. Application Information - Please Print Itifor ,1 _ Property Owner's Na me f CHUIX UUUNTY Parcel k Block A P roperty 0wrier's M ailing Address - - Pro erty Location City State - A, Section Zip Code Phone Number /� .ci c' }i � . /G�.� l� i �G� �2 �r3 Y� / �T� (circae } �r #Z3�7E� II. Type of Building (check all that apply') o T ; N; R / E or ` /� ca0 Svbrn t4 e I, 1 or 2 Family Dwelling / Subdivision Name CSM Number Y t►g - Number of Bedrooms L� Public /Commercial - Describe Use 47',- /7 ❑ State Owned - Describe Use Z } � --'� � _ C 41___yy� JC�V vvi� 1.1�i� ❑City�❑Village,�Township of III. Type of Permit: (Check only one box on line A. C omplete line B if applicable) A. New System ❑Replacement System I TreatmentiHolding Tank Replacement Other Modification to Existing System B . Permit Renewal ❑ Permit Revision I Change of i L Permit Transfer to New i List Previous Permit Number and Date Issued I Before Expiration Plumber ' Owner ner IV. Type of POWTS_Syste (Check all th app ly_) Non - Pressurized [n- Ground ❑Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade Li Single Pass Sand Filter LE L - XW 11 Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank E! Peat Filter D Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculati Synthetic Media Filter Leaching Cham ber ❑ Drip Line ❑ Gravel -less Pipe I] Other (explain) ' V. Dispersal/Treatment Area Info rmation: �� r ° G Design Flow (gpd) / Design Soil Application }2ate(gpdsf) Dispersal Area Required (sf) Dispersal Area Pro ed P,6 System Elevation i 1, 1 0 , / i / :,�I 1► l Z J Ll • 1 4�27 r VI. Tank Info Capacity in r Total Number�� Manufacturer Prefab Site Steel Fiber Plastic I Gallons Gallons of Units Concrete Constructed i Glass New Existing Tarots Tanits F t -_ Septic or Holding Tank Aerobic Tre ber atment Unit �- - � �- ---, Qosi' ng Cham _ p > taU — VII. Responsibility Statement I, the u ndersigned, assume respo nsibility for a tion of the POW TS shown on the attached plans. RS Plumber's Na me (Print) Plumber's Si gnature �MP Number Business Phone Number L/y1 ;71 j - .y0 ✓ Plumbers Addre ss (Street, City, State, Zip Cie) VIII. Count /De art Use Only _ _ Approved Sanitary Pert nit Fee (includes Groundwater Date Issued J Issui Agent Signa a (N Surcharge Fee) L/ C��� 6 7 �,. r Given Reason o nial �� I LX. Conditions of Approval /Reasons for Disapproval 3) Q�; ��, 4��r✓le db ra�Tt o �� ' SYSTEM OWNER: 1. Septic tank, effluent finer and Ae,.. p C3 + dispersal cell must all be services / maintained I as per management plan provided by plumber. I _ , - � � /Z- 2. AM setback requirements must be maintained as per applicable cote 1 ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) i e tom_ b GG QO� U s � P P C- P c�-- i ti4 �!1i:! I v � N D tY 0 v � � l ee CPI o — s 1` c; �a � o Ne b � O . i Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3 Division of Safety and Buildings in ccrda with Comm 85, Wis. Adm. Code County ST. CROIX Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. (Pending) pe rcent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Revie by Date Personal information you provide may be used for secondary purposes (Privacy Law, S. 15.04 (t) (m)). �Z � Property Owner Property Location VALLEY LAND CO, INV, PARTNERSHIP LLC t30vt. Lot = = == SP 1/4 NW 1l S 27 T 28 N R 19 Por Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 215 N. 2nd Street, Suite 102 -- -- (Pending) City State Zip Code Phone Number ity []Vllage JBTown Nearest Road River Falls, WI 1 54022 1 ( 715 ) 426 Bjerstedt Lane New Construction UseE] Residential / Number of bedrooms 3 or 4 Code derived design flow rate 450 or 600 GPD Replacement Public or commercial - Describe: Parent material outwash Flood Plain elevation if applicable -ft. General comments Conventi nal Ir> �Ee& 0.61 ading rate -- to be designed by designer or installer after location of and recommendations: dwelling established. DEC 1 1 2006 l Mod 1461 A- Boring T. CROIX COUN 100.25 TY 6rc" Bori a # Q pit Grou surface elev. Depth to limiting factor 70 in. Soil Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ffF In. Murrell Qu. Sz. Cont. Color Or, Sz, Sh, "EffIM1 *Ef #2 1 0 -12 10YR2/2 - 1 2f -msbk mvfr aw lvf m 0.6 0.8 2 12 -27 10YR4 /3 sil 2fabk mfr cis lvf - -m 0.6 0.8 3 27 -36 10YR4/4 -- sil 2fa -msbk mfr as lvf -m 0.6 0 . 8 4 36 -45 10YR4/6 - Is lmsbk mvfr as -- 0.7 1.6 5 45 -49 1OYR4 /4 - fs Osg dl as -- 0.5 1.0 6 49 -64 10YR4/6 - is Imsbk mvfr as -- 0.7 1.6 7 64 -70 10YR4/4 - fs Osg ml as -- 0.5 1.0 2 D Boring ❑� # 50 Ground surface elev. 35 ft. Depth to limiting factor in. Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eft#1 *Eff#2 1 0 -20 7.5YR2.5/1 1 2f -msbk mvfr ai lvf -m 0.6 0.8 2 20 - 33 7,SYR2.5/2 I 2fsbk I mvfr ai lvf - m 0.6 018 3 33 -41 7.5YR4/3 sl Imsbk mvfr cs lvf - -f 0.4 0.7 4 41 -50 10YR4/6 - sil Imsbk mfr cs lvf - -f 0.4c 0.6 5 50 -54 10YR4/4 m2d 10YR5/6&10YR6/1 c Om mefi -- -- 0.0 0.0 f u ate tflwa.- - JS� adn�'wr J� 1 Z. ova_ = _ > < TSS >30 < 150 *.Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L Effluent #1 - BOD 30 _220 mg/L and _ rng/L CST Name (Please Print) Signatu CST Number Mary Jo Hollister Avq 224832 Address Date Evaluation Conducted Telephone Number W9875 690th Avenue, River Falls, WI 54022 12-01-06 (715) 426 - 1775 I Property owner Valley Land Co. Inv. Partnership Parcel ID # (P ending) / Page 2 of 3 a ❑ 98.40 Boring # Boring ✓ Pit Ground surface elev. ft. Depth to limiting factor 56 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 -12 7.5YR2.5/1 -- 1 2f -msbk mvfr cs lvf-m 0.6 0.8 2 12 -30 7 5YR2 5/2 __ 1 2f -mabk mvfr ai Ivf -m 0.6 0.8 3 30 -38 10YR4/4 -- sil 2fabk mfr as lvf m 0.6 0.8 4 38-48 7.5YR4/3 -- sl 2fabk mfr as lvf -f 0.6 1.0 5 48 -56 10YR4 /6 -- US lmsbk mvfr as -- 0.5 1.0 6 56 -60 10YR4 /6 f2f 10YR5/6 Ifs lmsbk mvfr -- -- 0.5 1.0 ❑ Boring # f3adng a pit 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 Boring ❑ Boring # Ground surface elev. ft. Depth to limiting factor in. Pit Soil ication Rate Horizon Depth Dominant Color Redox Deerxlptlon Texture Structure Consistancxi Boundary Root 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. SBD- 8330Test (R.07 /00) Plot Plan for Site and Soil Evaluartion Page 3 Of 3 Property Owner VA u ct t-A Co. u -c-" g Legal Description A- mac.. L0e -AT IN -r V (except where noted) sE OF T#e NWA SEC. Z7 Tzs Rla w. 't0W4 of L1 — Backhoe pit 'CRfl`1� St CRv�X cov�ar I� v�SCags�iJ° .� ORES North &KCWr W No�� C ,� a t O 19L• yZ' pMC. p1PE BZ EI , S.Z ASOV& cm � a 100. loo. 0 gg 00 �. do A3 use. J 4 d�► tl� 7 S Site carbon: fi X I ry g c. Z7 C1 M FROM :SCHUMAKER PLUMBING FAX NO. :7153863121 Dec. 11 2006 11:13AM P2 ST, CROIX COUNTY SEPTIC TANK h4AINTENANCE AGREEMENT AND OWNERSHIP CEkTIFICATION FORM O .� s� Y' �i� �� OwthcriBuyer ef �c � �.®-.d � C� / -- -- -- Mailing Address Prop Address e-( �` Pro -l.r��'"" P Y " � 'i a atrnoent for Aew consinhctian.) (Verific rogn from Planrarng 3: Z�omng D p City /State _ — Parcel Identification Number - _ �L — / a(o -- Sa con--- - LEGAL DESCRIPTION Property Location ✓`L� '/a , � -'/4 , Sec. B , 'T N R Town of Sabdivision Lot it — . volume �' , page # Ce.rtltied Survey Map # _ Warranty Deed # _.. — -- _ _ ,Volume .� page it Spec house yes 6T i..ot lines idetuifsable SYSTEM MAINTENANCE OWNER CER tic s could result in itr3 prohnature failure to handle wastes. Proper Irnproper use and mamnancc of your sep maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities arc specified in §Comm. 83.52(1) and in t hapter 12 - St. (:roix County Sanitary Ordimace. The property owner agrees to s;uk,cnit to St. Ctoix C:outtty Planning &l...nning Department a certification form, signed by the owner and by a master plumber, Journeyman plumber, restricted plusrrber or a hcemsetl pumper verifying that (i) the on -sito wastewater disposal system is in proper operating cotuditivn and/or (2) after UwPectinn and purnping (if necessary), the septic tank 's toss than 1/3 full oCsludge, Uwe, the undersigned have read the above requiremchts and agree to maintain the private sewage disposal system with the standarcs set forth, herein, as set by the Deparinwnt of Cointnerce and the Department of Natural Resources, State of Wisconsin r7ettification stating that your septic system has been maintained must be completed and returned to the St. CYoix County Planning Rt Zoning Department within 30 days of the three year expiration date. Vwe certify that all statements on this form are true to the best of my /our knowledge. Uwe am/arc the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms � --- /a eG - SIGNATURE OF APPL,ICANT'(S) DATE ** *Any information that is misrepresented may result in the sanitary perrrhit being revoked by the Planning &:Coning Department.. * *" Include wit this application a recorded warranty deed from the Register of Deeds Office and a copy of the cettitied survey reap if reference is made in the warranty deed. (REV. 08105) POWTS OWNER'S MANUAL, & MANAGEMENT PLAN Page of FILE' INFORMATION OF +�k� SYSTEM SPECIFICATIONS Owner �\ Permit # V �.L Septic Tank Capacity Perm =vv al Septic Tank Manufact i �S ❑ NA RESIGN PARAMETERS Effluent Filter Man ufacturer Z mk) Ve— p NA Number of Bedrooms ® NA Effluent Fil M o d e( El NA Number of Public Facility Units 0 NA Pump Tank Capacity al ❑ NA Estimated flow {average) --� (. 00 gal V d Pump Tank Manufacturer Q. ot, ❑ NA Design flow (peak}, (Estimated x 1.5) (� s) /da Pump Manufacturer G o u.1 t.� ❑ NA Soil Application Rate allda /ft� Pump Model - O NA Standard Influent!Efffuent Quality w Monthly average , Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L C1 Sand /Gravel Filter 0 Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L Q NA © Mechanical Aeration ❑ Wetland _ Total Suspended Soli � -(( T -- S-S - -5-150 mg /L Q Disinfection ©Other: Pretreated Effluent Quality ! Monthly average Dispersal Calla) 0 NA Biochemical Oxygen Demand (ROD „) I x30 mg /L 0 In- Ground (gravityl O In- Ground ipressurized) Total Suspended Solids (TSS) f S30 mg& i7 NA Q At - Grade ❑ Mound Fec al Coliform (geom etric mean) 510” cfu /10 Q Drip -Line J Other: Maximum Effluent Particle Size Y in dia. ❑ NA tither. D NA Cl NA Other, ❑ NA `'Jalues typical for dGmestic wastewater and sapt c tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency inspect condition of tank(s) At leas once ever monthfs) y' °� {Maxi+num 3 years) n NA Pump out contents of tank(s) I When combined sludge and scum equals one -third Q of tank volume ❑ NA Inspect dispersal call(s) -- At least once revery ;�- ❑ Month (very; �— __ - 3R year(s) (Maximum S years) ❑ NA Clean effluent filter At least once every; ! 1 - [3 month(s) - - 0 NA Inspect pump, pump controls & alarm ` At leant once every: ,_ ., 0 month(s) -' —�- Q NA _ ❑ year(s) Flush laterals and pressure test At least once every: ,� a month(s) ❑ NA _ ❑ ye ars) month(s) ------ - - - -.. At leas o nce e very: - - ❑ yo Q month nth 1:1 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 celi(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 imn7ediate notification of the local regulatory authority. Lfteri the combined accumulation of sludge and scum( in any tank equals one -third (Y or more of the tank voturne, the entire ..witents 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 affluent filters, mechanical or pressurized components, pretreatment n and any servicing at intervals of S12 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. A •apo an11ail91wwpV u+suooslM 10 B (ZT 'I0vq`S6 Rua I;)8(p)1J 4)Ig)1e1,Cr - eq wu,00 Jaldequ 44!M eauvidwoo ui p044aip svM ivawnoop c u;, •uaty euoud etua jy ew¢4rl AtI�IOHtnV A!>?OtV1t10 111' d'! (H3;wnd) H V1J3d0 0N101Aa38 3DV1d3S 914043 /'�° 9ua4d awn ^s - ..�.._._.__ M k! 1 eweN !l3NIV1NIVW 1=04 d311V1SN1 S1MOd T S1N3WVW00 1VNOI110aV 318I8SOdYW !!Ey 41f101jd1,0 38 AVW )INVI V d0 11011131NI 3141. WOad NOSHU V d0 3nosak! '1inm AVW H1V3C '839NV1StJ�A0010 ANV WON )INV -L 111t3W1V3V.1 331410 U0 dWnd '031333 V kl31N3 lON OQ 'N30AXO 1N3i0Idj11SNl 130 /aNV S3SSV0 1VWJJ1 NIV,LIV03 AVW SHNV11N3WIV3111 113HJA (INV dVVnd '311d3S < < MIN > > 'awol 494110 loe ; ;e u4 selnl 041 411M Atdwoo Isms! OWSISAS lions ;o 9uo410ni1suooea 'aoel.ins 8nliei441JU1 844) le lewo!q 041 ;a 1 8AOW81 Bu1M011o; weld ui pelant46uo0pl eq Aeua SWB 1sA s u oe3di osge I►os apei8 -le pue ono P W Q 111MfSd Psilel e44 eopidoi 01 liO8B Joel e s e11B1 q Avw yual Bulploy a algelreAt $! e939 luauivoaldvi ou ;I epic ius"04146i slgr341ns a 9leool of pew ia;ia d a4 uolienlan® at's pua l!os a SIMOd 044 to •inpol uodn '8910 luoWeosldw ajgaRne a A; WOR 01 pownlena Us iou se 0118 0 4.1 'S1MOd P8091 941 00e1dei of POW pe {lelsul sq Asw )1u91 BUIPI04 a ABolou4oe4 SiMOd u! se0uenp9 61414398 suo1IBJ1W14 ;!os io /p41e 4 *04140 ni anp 01441tene iou si e91e luswealdel a4gei!ns y C1. isnu '844 1944 19 43949 ur semi 9 41 41!M Aldwoo � swalsAs lueweoeldaa '6030 l u9waoeldel etge3 a 4oltgeiss of uOI.wnjsne ails pus 110s Meu uodn a 10; peso 0141. 141 ilnsei II1M ease luaw000ldei ay1 10910id of Din1►sd s1lsm pu• *#611. 301 'ain3anala pasodaid pue 6141.1.81.x8 Wo11 139911 041 peilnbai o le I!o ;u! aq iou pinays pus uol4asdwo0 pus Dousg1r134 WOi; Mobl eq pinoys a l uvwaoeldei 941 u,01sAs uolldiosge IIoE 1uaw9oeldei v ;o uolieool 04,1 iai p•zggn aq Aiw Pug po onlenv ueeq se4 eei0 ius4uaaeld9i algeilns V � lue!ldwoo epoo a ap4noid of 'Us4el eq lsnw io 'useq SA04 96in99OW 6111 MO110; 0441 pelledel eq 1.0 pup• s p WOW90eldei ! I SIMOd 0 ;4 NV1d AON30NI1NO3 411M pell!1 00eds prop 041 PUB p9nowei 219AGO 31044 )a pGAbWBJ pue Polertaaxa g leualew p!4as lieul J9 44 0ue i 19neJ6 "ll q Ite4s slid pus s4uel IIB Bu!dwnd 1alpq • ioleiedp Bu1a)nieg 9603309 a Aq to pesodslp A13ad pug p•naua03 aq Ile4s slid pug sjuei Ile �a sluvl ayl • Telea9 sBuluDdo adld ppuopuagg 941 pue p040euu00slp aq !lays s11d pue a fuel of 6u1d!d IIV • WOO aouet d ge ,d en11e11s UISUODSIM ux�ioO �eldt34a itM s! welsAs 04 10441 ei nsul of lie el a woo u! peuopueales pue Aliodoid q Il Weis Bu1MO it o s 43 4 . 1 s00AS {0 ino u9je1 A411.181.191i.tled sl io /pue site; S1MOd 841 Uet4m 1 N3WNOCINVBV auuq iDUDuoffi id 4�4M PUB ;tuodu,ei :sui)ldeu Aie4lues :sapiollved :slonpoid 6u11u1ed 'sluela 'i,c :suo!.1eP :9 ;si9desiade iv lP :se a(; ieu, ;jeju rgle4 :090938 :eu 'eaullbod DlaBla88A pue 41m; :191em Idwnd dwns) uleip ua!lepu tNl 9p tsiaseeiSep :sg9MS uolloo 4 8WOPU60 ;slinq 914eiea!o ;sad M A e g nol 9 41 10 c )M 9 41 BuOloid Pug a0ueuil ;lad 944 enoidw! Avui weolla isjgmg,3s S1MOd enn 941 woi; BulnnaHo; 8 44 ;a uolJeulwg0 io ua,lOMpe t1a.0 U014daosg! HOg 9pe16 -1910 puno4u Aue ;o edols unno S 0930 9141 `1.90314:00 1c ginls4p es!M1e4lo is Mono lied ao OA1ap.lou ca 's 90 P 308; 91 YO II I esleds4 P Pug 9111491 iano 99101140A MOP io an!ip iou o(3 of sloiluoo dwnd 043 buwleiedo Alle u, islsse of ieu I 1 9114 a 'duel dwnd 941 u1 lu 411M slanel IawiOU eiolsai bul3olsei of io�id ioiei S 5 e A vdo Bu!olnie eBeida VV 51MOd 10 iagWnfd a loeluoo io dwnd enll 0 41 of i9Mod to 08 4 p aoelins io 30 os� q pvnoWel AU64 duind D41 10 slua4u00 043 ene4 uojlemle srtii prone 0 1. •luenll ;a aq I;!M ielenn04sens 9909x 014e 94 1. p91o1s93 q 9141. ur ilnsai Aeua pug 4 •44 butpvbIJQAO 'atop 98381 Duo 141 e1 iOMod ua4M '410A 19JgM 4 10siatls!p 0 41 of p083e40srp i!t 4 .4 te4tel anoga 111; Ae4u slluel dwnd saBelno i9Mod sujina •Doe ;ins en�le- J11gul 0 41 its uei0i; Bite suoglPuoo 1109 u04M m000 iou 11e4s do 11els u1aiSAS sluBiuoo 041 ene4 ;1a1091ep e;e Suo11e4u93u03 ' &on o11o1id 104919 Bu4olnlDS e6eldes a Aq penowei � 4s)alue1 044 i sl'?o!we4o 1.0410 slonpold But 1UIed to a0uasoid OW JO Is oui ed? aea eP io/Pus ss900id luewleeil ii 0 1 41 epedw! Ae4u 39 aBs�d 0 _.. 4 S-1MOd 9 43 to son 01 iotid 'uotlansuao Mau iaj )U - - -- NOI.LV?43+do QNv in 1jlV.13 START UP AND OPERATION pApe . - -- of For new construct ion, prior to use of the POWTS check treat tarfk(at for the presence Of painting pr o d ucts Or other Che►n ICaIS thet,.may impede the treatment process and /or damage the dispersal cejlfa). If high concentrations are detected !rave the conte of the tankls) removed by a septsge servicing operstot prior to usd, 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 effluent. 'To avoid l discharged to the dispersal cell( in one large dose, overloading the cell(sl and may result in the bank this situation have the con ba tent, of the PUMP tank removed b up Ope surface d ischarge of ntalner to 9931st n f manua ly atiing Ch prior to restoring Power to the effluent pump or contact a Plumber or #0WT$' Mal restore normal levels within the pump tank. 9 Pump controls to Do not drive or park vehicles over tanks and dispersal calls, Do not drive or park over, or otherwise disturb or comp within 15 feet down slope of any mound or at -grade soil ab the are sear' ptran area. Reduction Of elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby 6 e wipes; cigarette butts; G4ndoms; cotton swabs, degreasers; dental floss: di F c. foundation drain (sump pump) water; fruit and ve etabl apers; disinfectants: t a eefln painting products; pesticides; sanitary napkins; tampons; and water x0fte rme ass' herbrcades; meat scraps; medication&; oil; ABANDONMENT When the POWTS fails and /or is permanently taken ou at s i ce the following properly and t ent st shall p y safely abandoned In compliance with chapter COMM g p ra taken to Insure that the system is p 83.3, Wi sconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings seated. • 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 shalt be excavated and removed or their covers removed and the void space filled soil, gravel or another inert solid material, with 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: Q 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 front dipturbance and compaction: and should not be infringed upon uy required setbacks from existing and proposed structure, lot lieges and wells. Failure to protect the replacement area will result in the need for a now soil and site evaluations to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. Q 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 reeprt to replace the failed FOWTS. N t A" The site as not n evaluated to identify a suitable repleoemeht area. Upon failure of the POWTS a soil and site evaluation be performed to locate a suitable. replacement area. If no replacement area is available a holding tank may b tells s a last resort to replace the failed POWTS. Q Mound and at - grade soil absorption systems may 4e reCOnStrut ted in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems roust Comply with the rules in effect at that time. < < WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAt GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER A{�Y CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIPFICULT OR IMPOBSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Nstne Phone °7 / S' _ 3 g --� / oL / Phone SEPTAGE SERVICING OPERATOR (PUMPER) N ame G4CAL RBt3ULq?pRY AUTHORITY _ Name Phone Phone "n _ docUment was d•eftsd in compliance with chapter Cornm 83.22(2)1b)(1)(d)0k(1l and 83.54(1 f, (2) & (31, Wisconsin Advwnistravve Code. ' SEPTIC TANK E PUMP CHAMBER CRuS SBCTTO AND SP ECFF'ICA TIONS " CI VENT PIPE '12" MIN. ABOVE GRAD; WEATHERPROOF 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER FINISHED GRADE W1 PADLOCK 6 2 1 WARNING LABEL ,� CI RISES 4 MIN. 18" IN. 6" MAX. ' t i N L F. T + WATER TIGHT SEALS GAS- ' TIGHT t APPROVED A SEAL JOINTS WITH %PPROVED f B ALM APPROVED PIPE TPE 3 'ON 3 ONTO )NTO SOLID '"- 1 ' + SOLID SOIL. "'." + ifllL P UMP OFF ELEtl . FT. � { (}gF' k� RISER EXIT " D PERMITTED ONLY IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEDT)ING UN=k TANK CONCRETE PAD SPECIFICATIONS SEFTiC / DOSE TANK MANUFACTURER: , . NUMBER DOSES ?ER DAY: T ANK SIZES SEPTIC (j GAL. DOSE VOLUME INCLUD_TNG DOSE GAL. FLOWBACK: 9 GAL. ALARM MANUFACTURER: Lt wclgh m CAPACITIES A INCHES z L/� GAL. MODEL NUMBER: R L SWITCH TYPE: t*=sL B 2 INCHES = �-,�- GAL, PUMP MANUFACTURER: G� v . ,K-\ C INCHES = J GAL. MODEL NUMBER: r 4 SWITCH TYPE: rn ettC D INCHES - _ .. REQUIRED DISCHARGE RATE L 40 GPM PUMP & ALARM WIRING AS PER ILHR 16.23' WA ` DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . IQ- FEET + MINIMUM NETWORK SUPPLY PRES." E 2.5 FEET + Q� FEET F ORCEMAIN .L,lel1 T /100 FT, FRICTION FACTOR . , sp FEET TOTAL DYNAMIC HEAD = - �����I FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ,,_,, ; WIDTH •--•- DIAMETER --- LIQU DEPTS 3�g SIGNED: �. LICENSE NUMBER. a.Q qg o DATE: 1 %8B [O]GOULDS PUMPS Submersible Effluent Pump rr 3871 EPO4 EP05 APPLICATIONS • Fully submerged in high ■ EPOS Impeller. Thermoplas- ■ Bearings: Upper and lower Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing S following uses: lubrication and efficient improved performance. construction. heat transfer. ■ Casing and Base: Rugged • Effluent systems thermoplastic design provides AGENCY LISTING • Homes Available for automatic and superior strength and corrosion • Farms manual operation. Auto- resistance. rC' Canadian StandaMs Assodaw • Heavy duty sump matic models include • Water transfer Mechanical Float Switch r Motor Housing: Cast iron (CSA listed model numbers end • Dewatering assembled and preset at the for efficient heat transfer, In "F" or "C".) facto ry strength, and durability. SPECIF ICATIONS ■ Motor Cover. Thermoplastic Goulds pumas is iso 900111 Registerod. FEATURES cover with Integral handle and • Solids handling capability: float switch attachment points. 1 14" maximum. ■ EPO4 Impeller: Thermoplas- ■ Power Cable: Severe duty • Capacities: up to 60 GPM. tic Semi -open design with rated oil and water resistant. • Total heads: up to 31 feet. pump out vanes for mechanical • Discharge size: i Ih" NPT. seal protection. • Mechanical seal: carbon- rotary/ceramic - stationary, BUNG - N elastomers. • Temperature: 104 (40 continuous 1401 (60°C ) intermittent, to • Fasteners: 300 series stainless steel. s 30' -a► s on,t • Capable of running - dry without damage to s — ZS n components. Motor: • EPO4 Single phase: 0.4 HP, s zo 115 or 230 V, 60 Hz, 1550 RPM, built in overload with s automatic reset d 4 • EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, 110_ built in overload with EPO4 _ _. _. automatic reset. z • Power cord. 10 foot 5 standard length, 1613 11 SITOW with three prong grounding plug. Optional 20 °o �� 2 30 4a so GPM foot length, 16/3 S1TW with three prong grounding plug - -`� ` "- -- (standard on EP05). 0 2 a s s 10 12 m1 1h CAPACITY Goul P ump s 02000 Goulds Pumps t> ITT Industries Effective February, 2000 83871 STAMPAAD 08AM M 4ulck4 Standard Chambor w -_ .._ _ ...._,... _. _ ... __ ._ _ _ 44 ,. { (EFFt_CTWE LENGTH) �' :34` .._- ----- 510E VIEW ! sic, ' I on vltW i MultiPort End Cap 4 slur view TOP VIEW FRONT VIEW NY Quis St indud Cltitmbit.11oallnrli "Sl�icNi 0 00P; E l R ^End C9 11600 N� � 3wific ti0ns Size MxLxH 3,'x52'+12' Sln WzLx _ •" 3 4'x16'x12' Effect Len c� _ _ __._....M - Invert MeI tai 8,0 1 x25` >nven Height 9' i i I +►��!�IF'll,ISt�+ �Y,���i'i�±i�.fi..1IA�l� �►!!� ?� -f�S!f ,. ! Mwl".a +ww'++rwvilA�Wl u ,a'4 ".Iw�+.wY '•+sw . ,,. • , + f li i N;Y n 06n- 11YY In •n ww 0 **I ttvl rW+. ro,r ISWIw1Y +p t+1 Ftx9 rV.vAIIIW 41M U+�'0l rRJf+. 1r «,:.a r w+ 1 - c ,a rd1 +x AOQFGfl+l lfw ,tri+•1f1 0'wv 1 nvx! wa bMl}^ aF RC MlY 1+VN Yn.lwur!•Yt +'�IIn NIW+' halo ,On' ^� r ^ wr a - aW+W nxW r+WA, fRly+rwnr r+ wllrp s. u +,,yIVj K>w waer r +, rwru L. f ` w t v ! a. , �.+ np+YrvnrKJ+ kRiy/ffn r•1+1NI wsf11 A it,ti'.5'AIIfr1 Jiun+u' <rc '. inM ,r fA' IMrJIC. dll R'Jpl1 ,YO�CRr•» JIr1 ti . „+,y u , . _M w � I W Doll d gflr Ml+y rLINNGM � U « V,KY i i P1 WAG1sia;. , AHP rtF,+ifCl'A! S W BIfRF�,WA, �I'TA✓+ IM AAA r x lkd Kt' .1 A: it K•i d �' t}'11 Wf✓ +NY+( Non NI;IS*'... S%yS 1 � , j A /w' ' A 1 V + ,N: ,; \:(', irr „Y'C•r: R,i.I A1+R.'EP IMAFYi4A'tf6�JF ;•+iJJ "AQY.'n'.. str ��r.., .'.7f.JIN S l 'RP7 NY : ' F" T - K , .,i A rA,J lWM1 M fYp t•Td7M ) Mnl S rI1M ! t�9.1 Y tIV'!nY. pAk•Y t'WR M TM LCD xA Nr:r } , i . ;. ,Y v d. x 1eNl '. wletiraet sw yx► , en a r w as tw 3 ni Ye snr'IWxh m :ut�dlNts.lfW, �rwln4 t ff a ! ;. ,xi �. _n o a ,Y1W WY ,YM nfA cuo1� a e *« aw,Y+ . ,w�ww6 rictr j r w + krw it wYlYd ItM;Y + • ('.0 E3Gx i 6S 6 Busa i + j e n a� ..+rz w+r aa+' Sn Nra � J � +Y � W a A,: a K r.,,cnnmY cur 9t tl uIAI ,W✓P� ear. w ws Park Roe WdMM,'Y�+r�� �y ,ry �''�w� ['�.�. {� Cl (' t 1 y. ' , 'V SLL R, .R+ I,S F�'.L:� YO1 Q,, l9�rYl +Uw n•• R MIYf�'tlf '+117 YYRF +M +.VI� + �1�^M 1i i C1 1. rV1U Y�C�t R V C164 7. ! ♦ aw +„In NN nf+fNttX vMb ,Y� YaOn,Kw'y'+ •Y wo. -cad „dfflflk, IIfIPGUt o1 B,q,*- —,Aowr nr n �. aa�4Y, lesr�pm .assW++Wr.uuGp.''vxn0iyI11Ntl 7- ' / "t�()1 qF ;: w, .a;1. .,s ,+Wx - vnvoDf fti+ltii n l"n i+!IrLx tfllf+lo u0'MMY wig!! �I O++1R t�'IM Aft brrr+ +• ++Yw t+r"ur'� +�g�1, F�'l7 °7W 00 i�r « �� 860-t � •,nn� ; �, :«t•s ,,. xdktAl4 Th1 FIM9r1 NYIRir'll r`at W +!rQ +7lJV ,, Yrr d,r m wu� ,r 'laix[NiWi Mr a+'t' dIRM 1''Ihr•,ioFw.Iwi.MiM1.+xNMllse �IWN lrtrr i�V+wAI "r' onM SM- 221 -6438 } t. « caY:l: W tWClu ap +rr tnari Ir+w p" M,« , ..,Rw, ,wa,rt^rr w wy01'A f+p t , 9+1St to fM1WIR' `: +►pIR'tlb�d' ,q -., , �r •ny -x -■n YWU7K„Y +wfrnNUit haMF+'�'yr rw Y tl'C .atn er'v„ryk(AIY dMC brAI GOCf4: MpG'Vw,oWW,+'c. 1*1&W+ AA ," +tOffKf N"f �, r,iM VPepr3 ^ +1.1,ruttin!r NOW 1k) 0% 00 'l ' ! 7 ) ,',YU�d1 r4U!Wi � �. . 1+ 1:,Y lit H11 tYMK+I'oY tU'.rcM Off , .. • i - jpv. *W,81*0 fQrt". f n + na„+ww. A le•KIt1++ r '+Iwl kMdiUW +. pd 1YNi'twfA lo aMan e ! 11 It..:.e. r ,aR .,,,'ir ,,nn",i+rFww'Wrwia,lr,rY,Y r �.• nY,faReur.>M+, Ure11 sn,Y;r3 :,irtutt•.�,NN>KO � yry nw' b 4RY r'n-r ,+l ,,K�e .— .......+1 +:N g1UI:G.1U'A A+Y • 10� T 5,'xl l ;E, 9 41i1,:!Kt � pit +,eoa• +t.rte,taa, ;I,:� ,rt9; y.a�a.R+a a 1 w', 6.,bb f�Ik,1,,3Y• w "11ft-w sy~^ k q„rYe1 pt wrY a r iJV11+' 1.4 o', oanArc+U r 61Ni I 'r;F wig 71X'a + I +�1.11v1 M xifjtf� Cel'i6RV+ei Im `. il 4^41te f n 49• T +. Wr,v" ✓ ,„ t,cw.n' c1a aa,fliPlw' y (JCry 'c/'� t'h"na.rRC'�g flpU�cA 14uM'�,IX%M. C:+WRIIDMSCt�'M'. ." ; , «Ir" W. m N'M� ..ip[slplf, C.iO'1kW Pnn A -ml 1n wMCI. 81rslxn: N tdd ?1 $A U 28 ?_4P 165 , 797839 State Bar of Wisconsin Form 2 -2003 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI Document Number Document Name RECEIVED FOR RECORD 06/16/2005 10:00AN THIS DEED, made between David E. Cernohous and Cheryl A. Cernohous, WARRANTY DEED husband and wife ( "Grantor," EXEMPT # whether one or more), REC FEE: 13.00 and Valley Land Co. Inv. Partnership, LLC, a Wisconsin limited liability company TRANS FEE: 1265.70 COPY FEE: CC FEE: ( "Grantee," whether one or more). PAGES: 2 Recording 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 David J. Estreen needed, please attach addendum): 304 Locust Street See attached Exhibit A Hudson, VW 54016 UjI U15� 040 - 1105 -70- 000:040 - 1106 -50 -000 Parcel Identification Number (PM) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, ifany. Dated /I �7 (SEAL) - � � EAL) * *David E. Cernohous (SEAL) "� (SEAL) * *Cheryl A. Cernoh us AUTHENTICATION ACKNOWLEDGMENT Signature(s) David E. Cernohous and Cheryl A. Cernohous husband and wi fe 0 STATE OF ) authenticatg ) ss. COUNTY ) i ristina O lad Personally came before me on TITLE: MEM ER STATE BAR OF WISCONSIN the above -named Dale A. Evans and Mary E. Evans, husband (If not, and wife authorized by Wis. Stat. § 706.06) to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. TBIS INSTRUMENT DRAFTED BY: Kristina Oaland, Estreen & Oeland 304 Locust Street, Hudson, WI 54016 Notary Public, State of My Commission (is permanent) (expires: (Signatures 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 V 2003 STATE BAR OF WISCONSIN FORM NO. 2 -2003 * Type name below signatures. INFO -PROrm Legal Forms 800- 655 -2021 www,infoproforms.com U 282 4 P 166 EXHIBIT A A parcel of land located in part of the SE' /. of the NW' /4 and part of the SW' /4 of the NW' /. of Section 27, T28N, R19W, Town of Troy, St. Croix County, Wisconsin; described as follows: Commencing at the West Quarter comer of said Section 27; thence along the East -West Quarter line of said Section 27 N89 °21'28 "E a distance of 13.68 feet to the point of beginning; thence continuing along said East -West Quarter line N89 0 21'28 "E a distance of 2375.73 feet; thence N01 °33'38 "E a distance of 1001.45 feet to the centerline of Bjerstedt Lane as shown on Certified Survey Map In Volume 8, page 2180, at the St. Croix County Register of Deeds Office; thence along said centerline S89 0 51'42 "W a distance of 659.17 feet to the point of curvature a 285.50 foot radius curve convave Southeasterly, with a central angle that measures 45'50'13 ", a chord that bears S67 0 11'05.5"W and measures 222.36 feet; thence Southwesterly along the arc of said -curve and said centerline a distance of 228.40 feet.to the point of tangency; thence along said centerline S44 0 15'58"W a distance of 527.89 feet to the point of curvature of a 309.91 foot radius curve, concave Northwesterly, with a central angle that measures 42 "20'00 ", a chord that bears S65 0 25'58 "W and measures 223.81 feet; thence Southwesterly along the arc of said curve and said centerline a distance of 228.98 feet to the point of tangency; thence along said centerline S86'35'58'W a distance of 178.00 feet to the point of curvature of a 795.16 foot radius curve, concave Southeasterly, with a central angle that measures 17 0 09'50 ", a chord that bears S78 °01'03 "W and measures 237.31 feet; thence Southwesterly along the arc of said curve and said centerline a distance of 238.20 feet to the point of tangency; thence along said centerline S69 a distance of 391.78 feet to the point of curvature of a 240.00 foot radius curve, concave Southeasterly, with a central angle that measures 48'40'00 ", a chord that bears S45 °06'08 "W and measures 197.78 feet; thence Southwesterly along the arc of said curve and said centerline a distance of 203.85 feet to the point of tangency; thence along said centerline S20'46'08*W a distance of 140.93 feet to the point of beginning. Subject to right -of -way for Bjerstedt Lane and subject to all other easements, restrictions and convenants of record. A parcel of land located In part of the SE' /4 of the NW' /4 of Section 27, T28N, R1 9W, Town of Troy, St. Croix County, Wisconsin, described as follows: Commencing at the West Quarter comer of said Section 27; thence along the East -West Quarter line of said Section 27 N89 °21'28 "E a distance of 2389.41 feet; thence N01 °33'38 "E a distance of 1001.45 feet to the centerline of Bjerstedt Lane as shown on Certified Survey Map in Volume 8, page 2180, at the St. Croix County Register of Deeds Office; thence along said centerline N89'51'42 "E a distance of 229.13 feet to the East line of the Southeast Quarter of the Northwest Quarter and the Point of Beginning; thence along last said line N00'19'51 "E a distance of 318.15 feet to the Northeast comer of said Southeast Quarter of the Northwest Quarter; thence along the North line of said Southeast Quarter of the Northwest Quarter S89'19'46 "W a distance of 892.76 feet to the Northeast comer of Lot 1 of Certified Survey Map Volume 8, page 2180; thence along the East line of said Lot 1 S00 9 08'43 "E a distance of 309.85 feet to said centerline of Bjerstedt Lane; thence along said centerline N89'51'42 "E a distance of 888.30 feet to the point of beginning. Subject to right -of -way for Bjerstedt Lane and subject to all other easements, restrictions and covenants of record. Parcel #: 040 - 1106 -50 -000 02/15/2007 04:27 PM PAGE IOF1 Alt. Parcel #: 27.28.19.423A 040 - TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - VALLEY LAND CO INV PARTNERSHIP LLC VALLEY LAND CO INV PARTNERSHIP LLC 215 N 2ND ST STE # 102 RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 30.304 Plat: N/A -NOT AVAILABLE SEC 27 T28N R19W SE NW EXC PT TO CSM Block/Condo Bldg: 8/2180 & EXC PT TO CSM 8/2181 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 27- 28N -19W Notes: Parcel History: Date Doc # Vol /Page Type 05/01/2006 824048 EZ -CN 06/16/2005 797839 2824/165 WD 11/12/1997 568399 1276/329 WD 07/23/1997 864/518 more 2007 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 07/20/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 27.304 4,900 0 4,900 NO UNDEVELOPED G5 3.000 300 0 300 NO Totals for 2007: General Property 30.304 5,200 0 5,200 Woodland 0.000 0 0 Totals for 2006: General Property 30.304 5,200 0 5,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00