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024-1043-30-200 (2)
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Buliding Division INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) 645484 State Plan ID No: Personal Information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1 xm)I Permit Holders Name: City Village Township Parcel Tax No: Anthony F. Novak and Oanh Constance TOWN OF PLEASANT VALLEY 024-1043-30-200 CST BM Elev: Ins . BM E v: B Descnplon: Section/Town/RangelMap No: d ;YK�i ►a '�Ak (M ;x._� As hill I /" wyll lDv (I 33.28.17.280E-20 TANK INFORMATION TYPE MANUFA TU R S�e yr CAPACITY Septic V l r} I Dosing t Aeration Holding TANK SETBACK INFORMATION---I'nlrnr„cii nnvtGl/ TANK TO P/L WELL BL Vent to Air I take ROAD Septic ; V 2)I ,I1 l � Dosing 716 t 7?/r I 7�51 Aeration Holding PUMP/SIPHON INFORMATION V Manufacturer Demand GPM Model Number TDH Li FnctioI os& Systeryl Hd TD t Forcemain Len! ,, Dia. 11 Dist, to Way,, SOIL ABSORPTION SYSTEM DIMENSIONS SETBACK ISYSTEJAVO INFORMATION DISTRIBUTION SYSTEM :.. ram �. ... d ' l 1 --- / r'Bot. System CHAMBER OR UNIT Dia. Header/Manifold Length Dia ALi Distribution 1 �t x Hole Size x Hole Spacing Vent to Air Intake is S Depth Over Depth Over xx Depth of - - - -- xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yea ❑r � No (� Yes }, No I.UMMr-N I S: (Include code discrepancies, persons present, etc.) Location: 1736 CTY RD MI' 1.) Alt BM Description 41-w wo 2.) Bldg sewer length = _opal - amount of cover = r {7 y Inspection #1: Inspection #2: �arsrr�C� �l►pu yab� Plan revision Required? Yes *No fipc Use other side for additional Information.SBD-6710 (R.3tg7) Date ors Signature Can. No. 5f) "-Du as — 360 A Industry Services Division County C %Z 6 I 4822 Madison Yards Way Sanitary Permit Number (to be filled in by Co) p Q �O� NOV b 0 Madison, WI 53705 P.O. Box 7162 Madison, WI 53707-716 ► Applicatio State Transaction Number mn In acwrdance with is. Adm. Code, submission of this form to the t Dwscsubm�iu�ed Z Z 00 Q �J Project Address (if different than mailing address) is required prior to obtaining a sanitary permit. Note: Application forms for state-0 the Depament of Safety and Professional Services. Personal information you provide be used for secondary, in accordance with the V iv Law, s. 15.04(l)(m), Stats. tG Property Owner's Name Parcel 4 200 (v AJ O z /0 3- o va Property Owner's Mad ing Address Property Location 1> Govt. Lot G wG r. ' Jr ✓' /..� ry '/.. Section T Z V N R Ecez City, Sm �j / , ! ' `` ` Zip Code 8•_ /Z ' CY 7 �^+ \ Sf o Z. Z Phone Number /� 7 1 � � - C/ .7 0 Z Lot g Subdivision Name {4Ior2Family Dwelling - Number ofBedrooms V•�t % c-- []PttblidCommercial - Describe Use Black R ❑City of 11state Owned - Describe Use illage of CSM Numbe 3f9' 6g5`I' �' W J/wi• � 1 � / 0wnof��r-41A Jf kr��.-�(i �r -fIf' Tyke 0f I'ONVTS'Nrriiit: (Check"either" : ew^ or °Replacement Check one boz online-B: Ciihiritefe line Ci ::a livable: _.�.ifGi''. �?^ar�.i=„a. d•' t, ,..... A. (� ew S stem l__.i' y �teplacement lL_JJ System er Modification to Existing System (explain) Additional Pretreatment Unit (explain) KC —Pe -A- e B' [:]Holding Tank ❑In -Growl [:it -Grade Mound 2 Individual Site Design Other Type (explain) (conventional) C. ❑ Renewal Before r •Revision DChange of Plumber ❑Transfer to New Owner List Previous Permit Number and Date Issued Expiration V7yz95- 7-T-0s Design Flow (gpd) Design Soil Application Rate(gpolsf) Dispersal ArepJtequD (sf) Dispersal Area Proposed (sf) System Elevation Tank Information Capacity in Gallons Total Gallons g of Units Manufacturer New Tanks Existing Tanks &,&6F—to 1 0 y au 6i a C7 a septic ot Holding Tale D o 0 e 0 � /e'fepx— Dosing Clamber Plumber's N e (Prim) Plumber's Signature MP /?l&PWM Number Business Phone Number �Zip 'Code) % Plumberl A (Stray City, State, pproved ❑ Disap v Perrmiitt.Fee Date Issued Issuin Agen` Signature ive n for Denial 1� 3Q �j Conditions A prov aeeeeferBizapproVal -,/ M OWNER: 3) IDS Peraµ� r�,tC•ew 1. Septic tank, effluent filter and dispersal cell .1) t l �zrar r rt1111* be serviced 1 maintained as per IMOMement plan provided by r plumber. � _£ Al setback requirements must be maintained Qtrryet�'Ut� J1Q�►aa�. appWable Gfti boom bn n•rn.M..v.......�...��:.._.�_n___�.- tj03 ba j ` ,.�r'D�i[rncpasm qt VVL�� Daa pw. Rym Be" 0 2022 Advanced CrBlled Sol Twter. f&WM Environmental LLC. DedWw of B*amr6lq SyAmK D 22M-7 An fines resav d. SCALE 20' 0' 40' A DYA LA C E D 'Nl pmperty laws not o e rk drawn are >100R fmm ��� SYSTEM NOTES SeoTalc: tle E N V I a O N M E N T A L eyalem Zustiq Wow 1MMO09W AD* to be abMd W pmrSPS 3dd333 rdr*kWedhnew Wow IOOOl550 gd m 2aaryarwent lank o\ ARgBaasVaWAfoalgads 4W GF-IO Bbr wlaWm + + + + + + + + + + ++ + + + + + + + + + + + + +gam + + + + + + + sri=1eo.00 + ,+ + + addition + Q + T �+ �`-, . - � Tree + + + + / InaII BM) + _\ line — — — . + + + +I + 3BR�Home ; TO7 _����- \ 6astlr,g 8' x 56.25' /sd, 4o0Pvc `+ 1 mound t170' 2" / (new)' �J - sch 40 PVC d-'- �`�_ .. _11IMSEIN) I Insulated under L-- / •�\ -~.�`�`` ---- D .`driveway per as -built hVe�1ti/ ____ LOCATION MAP (rat to da) Field / edge ---------------------- /Tr----- ------- ----------------- ---------------------------------------------------- SITE CTY RD M PREPARED POIC Mtltony Novak Ste RD Address: Mvveer lM s, WI54022 PID: 024-ID43-30-200 34.83 Acres Town?/N oof8Pl�n�/YV t Vdl ey amrd aedw" 71i MMm hae bowl dedp and MW mated ti moaawrw der nor aid teed ardn. 71w .aa Nearest am swot"'oche" aan dMaaaw ad/a• Apra taea. od dlr axwYiwar� � �,.,r.. �. _ .n rwr. �nrx n� -r ----- —rPP//L�pi '+ _P/L Pmo Took -WPIaa 'Y ;_' + + �+ -MPnaadUM31g'ng25tg1 /6nd�tiedQO toF_D�r}Q �/ �� + +, + •ea.rik.naaa.y,m.r.a�.e.da 4bcdeMrpop RdmLm&idMHdiIndd {wwdootxlr, Ine mdr, a wrwinlr dawmiadrd SPSf383.3+ + + + + + + + SoB Treatoeeat Area 4W=Wad bsd*q Cx mz Wpw mand -hJewl Vdlesel' 1jM/65b � 5doAndapwx»tromamvecaon ddny w�pest C+10 fiW_ + -Dola awen•1r + r + —�.+ + P o,+ ±20' 2° - sch 40 PVC utility () dim&*bWmYWftWa•bd sheds -D~4 dm floe sdNo pw lope r♦MI�u L,! Division of Industry Services 2331 San Luis PI Green Bay, wI 54304 %ywW dsps m 4av l` _ µ • -l; L Alp Tony Evers - Govemor Dan IlarIII - Saerehry November 3, 2022 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2024-11-03 Plan Review: PWTS-112200080-M RYAN GARY BECHEL 779 Spring Creek RD S Red Wing MN 55066 SITE: 1736 Cty M Town of PLEASANT VALLEY St. Croix County Total Amount: $80.00 Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES FOR: 450 gpd — 3 BRs — Miscellaneous Review — Tm*Jkq itltl g" 14" Limiting Factor— Ellluent Filter — Maintenance Required Mound Component Manual — Ver. 2.1 (May 2022 - 2027) Pressure Distribution Component Manual — Ver. 2.1 (May 2022 - 2027) SEE CORRESPONDENCE The above submittal has been reviewed for conformance with Wis. Admin. Code (WAC) & Wis. Stat., and has been CONDITIONALLY APPROVED. This private onsite wastewater treatment system (IN)%= shall be installed in accordance with the enclosed approved plans and any above referenced component manual(s) and specifications. The owner, defined in Wis. Stat. § 101.01(lo), is responsible for compliance with all code requirements. Prior to install, a from the county where located and inspection shall be arranged per Wis. Stat. § 145.19 and 145.20(2)(d). No person may engage in or work at plumbing unless licensed to do so per Wis. Stat. § 145.06. A copy of the approved plans, specifications, and this letter shall be onsite during install and open to inspection by authorized representatives of the Department. All permits required by the state, county, and local municipality shall be obtained prior to commencement of any construction/install/operation. This approval shall be subject to the following conditions: size soil sample shall be kneaded & rolled into a ball If it can then be rolled into a wire down to 1/4-inch thick the site is too wet to proceed if it crumbles before reaching 1/4-inch thick the site is dry enough to proceed, • Prior to plowing POWTS dispersal component area, tall grasses and shrubs shall be cut short and this and all loose organic material shall be removed from the area to prevent matting. • Areas occupied by rock fragments, tree roots, stumps and boulders reduce the amount of soil available for proper treatment. If no other site is available, in the POWTS dispersal component area, at around level and removed, along with boulders; stumps and roots shall remain in place. A larger infiltrative area is necessary when any of the above conditions are encountered. Page 1 of 2 • POWTS component areas & horizontal setbacks jhjLkLgMMjjUj prior to and during construction — prevent disturbance, compaction, fill or use of areas. • Horizontal setbacks of all POWTS components and lines, especially from buildings, OHWM of navigable waters, and wells, Jbifift>iji" prior to install to conform to WAC § SPS Table 383.43-1. • Wastewater from contractor equipment & tool use & cleaning and leftover products shall not be discharged to POWTS but shall be otherwise properly disposed of on or off site. • Tank install shall conform to all manufacturer's requirements. • All piping shall conform to WAC § SPS Tables 384.30-3 and 384.30-5. • Insulation of building sewer length beyond 30 feet shall conform to WAC § SPS 382.30 (1 I)(c). • Existing, unused POWTS components shall be abandoned per WAC § SPS 383.33. • Surface water diversion/drainage away from all POWTS component areas shall be provided. • Changes impacting dosing require state verification of TDH & GPM specifications. • For new construction, it is recommended to not activate dose pump(s) until all tanks are pumped by a DNR certified septage servicing operator after conclusion of all significant construction and interior finishing. • provide owner a copy of this letter, the owner's manual & management plan, and all instructions for proper operation & maintenance of this POWTS, for which the owner shall be responsible, per WAC § SPS 383.54(1). Owner shall provide this information to any subsequent owners. • QNiftla report each inspection, evaluation, maintenance, or servicing to county per WAC § SPS 383.55. • If any POWTS component malfunctions so as to create a health hazard, the owner must follow the contingency plan described in this approval. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. Nothing in this approval shall relieve the designer of the responsibility for designing a safe building, structure, or component, per Wis. Stat. § 101.12(2). Inquiries concerning this correspondence may be made to me at the telephone number or email listed below. Best Regards, Jake Shedivy I POWTS Plan Reviewer Jacob shcdi%c a \ci Soy 1 608-261-7932 Page 2 of 2 ADVANCED E N V I R O N M E N T A L Property Owner/Client: Anthony Novak PIN: 0241043-30-200 Site Address: 1736 CTY RD M, River Falls, Wl 54022 County: ST Croix INDEX Pg 2 SITE PLAN Pg3 TANK SPECIFICATIONS Pg 4 DOSING AND PUMP SELECTION Pg 5 FILTER MAINTENANCE Pg 6 MANAGEMENT PLAN Pg 7 MANAGEMENT PLAN Pghl. 8-22 AS -BUILT PERMIT Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES i DESIGN PARA METERS SEE CORRESPONDENCE FLOW. Wastewater Type: Residential Estimated Wastewater Flow: 300 gpd Design Flow: 450 gpd SOIL & S17F EVALUA770N.• POWTS Type: Mound Limiting Condition Depth: 14" Maximum System Depth: Above Grade Contour Elevation: 96.00' Limiting Condition Elev: 94.83' Land Slope: 7°% # Bedrooms (residential): 3 # Occupants (per capita flow) : _ Public Facility Flow: NA Treatment Level: Effluent 1 Code Required Separation: 36" Soil Texture: SICL In -situ Soil Application Rate: 0.4 E Dispersal Cell Loading Rate: 1.01 POWTS DESIGNED PURSUANT TO: Mound Component Manual (Version 2.1) Pressure Distribution Component Manual (Version 2.1) Comments; REVISION REVISION: Removing existing septic combo tank to build garage addition. New Wieser 1000/650 combo tank to be installed 30 feet east of existing tank location. No changes to existing 8 x 56.25 .�""C N����, mound system or site flow (existing 3 bedroom home). g g �`��5 RYAN G. _�w__—_____----- -- -- -------� BECHEL = = D-2263-7 SIGNED: 10/26/2022 REDMNING ADVANCED EN IRONMENTAL LLC '`''40E-S (G x��```.```��� 779 Spring Creek RD S, Red Wing MN 55066 (651) 327-0074 /$r,,,,,11MI`�� DmWw. Ryon Beer © 2022 Advanced CaMW Sol Tester: 133OB32 Environmental LLC. DnlWw of Enow rYlq Sleteme D 2253-7 AM rights reserved. SCALE. 20' 0' 40' ADVANCED .All Pnp>r firm rot 0 Benolrrawk SVSTRM NOTES dawn an >1001t from Seek Taa1r. •1�'^ Sol -E" Wieser f 000600gd trii to be abendorwd per SPS 363 33 erd replaced we new Wemr 1000t W gallon 2-wn renenl lank a q risela r abws Ind grade 4er1 GF-10 MW wl shim Pn I I 1ti I I Pti ►A. I r Pn. I PA.r� + + + + + + + + + + + 'p'''� + + + Exi ng Wieser + + +-pwPng&-31gpm0BTD+ _ nd + + + + +' + + + + + �'g� + + fin % + + -�j• pm Lost WT�kldFMW + + + + + .+ + + addtion _ SPS-383.33- + + + « + ( qo$ +- T�fi +/ —- \I I } s-0ora9rIarmlsaat7mwntlooat wArea: + + / - ou ation line New -PammMlo agrrsez n taen0osoglo' n ffearwwqrd syM origin BM)+ IbO/6Sb + + + + t + + \ — — — w/-Best G4-IU nOr— + �,gl,w,wl�m•w + + + ++ 36R\Home --- --r _+_ + + �Veil_ - o + _ ,+ \ EAsting / t30' 4" \\ i l % t20' 2" Y 8' x 56.25' 1 l seh 40 PVC D4Mbetloo: \ ound ftbA t 170' 2" f / sch � (new) i -J ( ) sheds mr or sebrgs pv � l sch 40 li E % — -C&Isting) � ; _ Insulated under O'.,__ driveway per as -built Field r Al' eW,ay --------------------- LOCATION MAP Owl Iedge '�---------------------- ------ o SITE i CTY RD M PREPARED FOR: Anmany Nowelk P, F� 1736 CTY RD sexAdare�: Q�P /, /, /, �r �ls• wi'4022 PID: 024-1043-3D`200 34.83 Acres Lew: t 02 CSMw 31-8959 SW 1 S33 7= R1 g Town of Pleasant Volley Wism ft m. 10Y r ee.n re -ew.r dar/ra ens 04'*W In .aeere.re..ur eiiw N Lai sea 11r d aerwre a 'wir "hill PeaerM M sm"m w41v e■wD.errw sew..r ae...a.erwsi. 4-- - . n ewwwrnv r �rr�r w w e�em� rI �w W � M� wwaarne�v e�.r.� _. r ..�.+. • s -- .�. . - - • .r �... - - — ...� .� r Scale: 1' - 40 Date: 10/26/22 TANK SPECIRC4 TONS • Minimum cover = 6 inches; Maximum cover = 8 feet (unless specified by manufacturer) • All manhole covers shall extend 4 inches above final grade • If the tank is within 2 feet of final grade, insulate the lid to an R-Value of 10 • Minimum 18" of cover required over building sewer, • Insulate if greater > 30' long and < 420from grade or if < 60"from grade under all high traffic/snow cleared areas (driveways etc.) • If forcemain will have a •J-Hook' assembly, drill a weep hole in the 'hook' • Building sewer. No 90's, keep 3 feet between 45's, maintain 1 inch in 8 feet (1%) slope, install cleanouts watt thl contra bo. w4n zh Seyelson w.nna and am arc OuK k Dlecon nect Clean OW ----------- It"eamaW m 4' SCH 91.2586.62' -- — 40 PK ppe a(ron tank • e.watlontoaevenlooe 4' N 40 Effluent Fate( WIN", 1 %1 5' PVC Float Tree i +/— MY 83.78' Pump OMI . Y"" Hole 82.7(r 4' Pump BbFA Tank Manufacturer/Model: Wieser- WLP1000/650-MR____ --- Filter Manufacturer/Model: Best -GF-10 -- -------------- ---------------------------------------------------- Panel Manufacturer/Model: SJE Rhombus - Tank Alert 1 WLP1000/650—MR TANK SPECIFICATIONS DIMENSIONS: 146' MALL: 3' BOTTOM: 3' MANHOLE 24' I.D. PRECAST CONCRETE RISER HEIGHT: 54 1/2' O.D. i LENGTHS 146. O.D. — — — — = — — -- WIDTH: 64' O.D. ' LOW INLET; 43- CAST -A-SEAL 4' CAST -A -SEAL LIQUID LEVEL: 31r O.D. Ni II WEIGHT: 14.940 LIM e2� / INLET AND OUTLET: 4' CAST -A -SEAL BOOT OR EQUAL qq GASKET. CAST -A -SEAL BOOT OR EOUAL i 11 Nr I INLET AND OUTLET BAFFLEFILTER. FILTER OR WISCONSN. SEE AIL VO I BAFFLE NI I (OTHER STATES SEE CHART) S o C — — — — — -- — -- LK"O CAPAOTV: 26.32 GAL/N (SSEPTIC) 17.00 GAL/N qq W (P(MaP) R' x W TOP VIEW LOADING DESIGN: 6' O' UNSATURATED SOIL Y�a � �F a Ytao TANK CAN BE USED A5: tn� 4' VENT OR SE/SEPTIC. SEPTIC/ PUMP oR sEPnc/sIPHGN a n � o "j I COVER: MIX DESIGN #6 ((NO FIBER) CO TANK: MIX DES" /10 (STRUCTURAL FIBER) d CUSTOMIZEDS Q FOR CUSTOM TANKS CONTACT MIESER CONCRETE I 4 1R II I i 3. °"Y° PAD DRAWIN65 SUBMITTED F # ,Sal FOR APPROVAL SIDE VIEW APH ED 91: SHEET No. aPmovaL DaTI: 1 / TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTY C-1227 REOINREMENiS Pao CTS %LLUD N.: � 1 DOSE SETTINGS & PUMP SELECT/ON PUMP PERFORMANCE REQUIREMENTS Elevation Head: 14.7' Distribution Head: 6.50' Equipment Head Loss: 0.0' Forcemain Friction Loss: 3.9 ft TOTAL DYNAMIC HEAD = 25.1 ft TDH MINIMUM FLOW RATE = 30.8 gpm DOSE REQUIREMENTS Minimum Dose: 51.1 gallons Maximum Dose: 90.0 gallons Design Dose: 71.0 gallons Forcemain Feet: 190' Forcemain 0: 2.0" Drainback: 31.0 gallons TOTAL DOSE = 102.0 gallons VIA FEET PEST 3 1u PE41 25 20 15 10 5 00 Goulds - PE-51 -014_ 2 GPM t Ft :7 ■ 86.12' 84.S3' 84.28' 83.78' 82.95' MODELS Pf 31. PEA I, ►f $1 HP 33. 40, SO 10 20 30 40 50 60 70 GPM 80 F 11 87.24' Ii •• f 323.0gals 19.0" A (RESERVE) ------------- 51.0 gals ----- ----- 31 ----- B (ALARM) 102.0gaIs ' 6.0" C (DOSE) 170.0gals 10" D (PUMP COVER) H ------------ -- , 2: 1 Goulds - WE05HH 1 FEET 130 wet ewt SERIES WE 120 SIZE. '/.' SOURS .__ RPM 3500 3 110 WEIEN 1750 }� 5 Gf+.' oo 5 FT 90 tfN 80 1 70 07 60 5WEO 0 OSN 40 30 M K"" 20 WE02L 10 4101) 4u 00 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 16C Installation Instructions for the GF10 Filter Sap 1: Locate and remove the septic tank cover, on the outlet side of tank Step 2: Before Installation, place the filter case on to the outlet pipe. Make sure the case Is positioned so the fitter can be removed from the tank for malnte- nonce and service Step 3: For Installations that require or desire additional support. Of additional support Is not needed, go to Step 4) Glue a sectlon or 1' Scn. 40 pipe to the two hubs located on the bottom of the case and the hub located on the side or the case. i1i7lw � 0� 1 Stop 4: Glue the filter case onto the outlet pipe. Insert the filter cartridge Into the case. (Make sure the fitter Is completely Inserted Into the case) , rwOolo�TDCHI$OLOGT Sap S: For Installations where It will be dhTxLgt to react the handle, place 1' Schedule 40 pipe Into the tee on the handle and extend It to height that will make it easy to remove the filter. Installation of an scams ..new system only the septicarsk , existing system. mug bepumped priorto Installation. ' i——— — ------.., .. — --- — --ad Maintenance of the GF10 Filter A time frame In which septic tanks are serviced is set by state and kcal codes Although they may be different, most regulatory agencies suggest two to five years We recommend the GF 10 fitter be cleaned when the septic tank is normally cleaned and pumped, or as needed WARNING: If the liquid level in the tank is above the top of the filter, pump the tank prior to removing the filter cartridge. OCAUTION: USE RUBBER GLOVES WHEN HANDLING FILTERSI Step 1: Remove the septic tank cover and pump the tank If necessary to prevent any solids from escaping to the field when the filter Is removed. tas I Stop 2: Pull the fitter handle and slide the fitter out of the case. Step 3: While holding the filter cartridge over the access opening of the tank, rinse the cartridge off with fresh water. Take care to make sure all solid material falls back Into the tank BTECHNEOLOGYST / 3 Falrlield Blvd, Wallingford, CT 06492 14t)1.7a4esi Fax 204284-8614 Stop4: Insert the cartridge back into the case making sure that it Is properly aligned and completely Inserted Into the case. 'ape 5 MANAGEMENT RAN The owner of this Private Onsite Wastewater Treatment System (POWTS) shall be responsible for Its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. This management plan identifies operation and maintenance activities necessary to ensure longterm system performance. Tasks that should be performed by the homeowner are Identified. Professional management tasks shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code, however, It is the homeowner's responsibility to ensure all tasks get accomplished in a timely manner. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. ► Keep this Management Plan with your Septic System Owner's Guide. ► Keep copies of all pumping records, maintenance activities and repair invoices with this document. ► Review this plan with your POWTS Maintainer at each visit; discuss any changes in product use, activities, or water -use. MANAGEMENT FREQUENCY Parameters Number of Bedrooms Design Flow (gpd) 45( Soil Loading Rate (gpd/ftz) 0.j Standard Effluent Quality _Effluent 1 Biological Oxygen Demand (SOD) 220 nrg/f Total Suspended Solids (TSS) 150 mg4F Fats, Oils, Greases (FOG) 30 rro Treated Effluent Quality Biological Oxygen Demand (BOD) - rr(q// Total Suspended Solids (TSS) - M94 Fats, Oils, Greases (FOG) - trig// Max Effluent Particle Size (in) 1/8 Septic Tank Manufacturer Septic Tank Capacity (gallons) Effluent Fitter Manufacturer Effluent Filter Model Pump Tank Manufacturer Pump Tank Capacity (gallons) Pump Manufacturer Pump Model Dispersal Cell Type Pretreatment Unit Description Homeowner Management Tasks I Professional Management Tasks Check (listen, look) for leaks In toilets and dripping faucets. Repair leaks promptly. Regularly check for wet or spongy soil around your soil treatment area. Contact service provider if Issues arise. Control burrowing animals (gophers, groundhogs, etc) Keep bikes, vehicles, snowmobiles and other traffic off treatment area. Alarms - Contact your service professional if any alarm signals. Lint Fitter- check for lint buildup and clean when necessary. If you do not have one, add one after washing machine. Caps - Make sure that all caps and lids are Intact and In place. Inspect for damaged caps often. Fix or replace damaged caps. - Check and clean per recommendations. Per Per Mound I Liquid levels - Check sludge/scum/effluent levels in all system tanks. Recommend It tank(s) should be pumped. Pump all compartments every 36 months at a minimum. Inspect tank inlet and outlet baffles (If applicable) Check drainfield effluent levels (if applicable) Verify pump and alarm system functions (It applicable) Inspect wiring for corrosion and function (If applicable) Clean drainfield laterals (if applicable) Check event counter/elapsed time meter and evaluate water usage rate compared to system design flow. Check dissolved oxygen and effluent temperature In tank. Check for surfacing of effluent or other signs of problems. Verify inspection pipes are capped and Intact Provide homeowner with list of management results and any action to be taken. sjtem Avp&cement anaw sae /lam Mrflrg campiwoon, eM (it applcaole) POWISREGULATOR.• STQV&00U1*Z0n11W0fflW — — ADDRESR 1101 Q 1MICh" RD, SuKe 12W, Hud8on, W154016 PHONE (715) 3W-MM PAnn R START-UP & OPERATION For new conattfX141o; Prior to system operation, check septic/pump tanks for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cells. If high concentrations are detected, have the contents of the tank removed by a licensed septic professional prior to use. System start-up shall not occur when soils are frozen at the infiltrative surface. During • Pump tanks may fill above normal high water levels for system utilizing pumps. When power is restored, the excess wastewater will be discharged to the dispersal cell in one large dose potentially resulting in overloading of the cells. Backup or surface discharge of effluent may also result. To avoid this situation, it is highly recommended to have the contents of the pump tank removed by a licensed septic professional or have a septic professional manually dose the system to return the pump tank to normal operating levels prior to restoring power. Do not drive or park vehicles over any septic system components. Do not drive, park over, or otherwise disturb or compact the area within 15 feet downslope of any mound or at grade system or secondary septic system site. Inspections of tanks and dispersal cells shall be made by an appropriately licensed individual or nusiness. ianK mspecuuns muse 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 backup or ponding of effluent on the ground surface. Access openings used for service and assessment shall be sealed watertight upon completion of service activities. Any unsound/defective access openings shall be replaced immediately. 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. Ponding of effluent on the ground surface may indicate a failing condition that requires immediate attention by a licensed septic professional. Tanks must be pumped when sludge accumulation is within 12 inches of the bottom of the outlet baffle, or whenever the scum layer is within 3 inches of the bottom of the outlet baffle. In no case shall total sludge and scum volume occupy greater than 25% of the tank liquid capacity. The effluent filter shall be cleaned as necessary to ensure proper operation. The filter should not be removed unless provisions are made to retain solids in the tank that may slough off the filter during removal. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent fitter alarms may indicate surge flows or an impending continuous alarm and should be evaluated by a licensed septic professional. Pre-treatment components shall be maintained and serviced by a licensed septic professional according to the manufacturer's recommendations. If the septic tank, or any of it's components, become defective the tank or component shall be immediately repaired or replaced according to the original system design specifications. If a dosing tank, pump, pump controls, alarms, or related wiring becomes defective, they shall be immediately repaired or replaced with components of equal performance. If the soil treatment component fails to accept wastewater or discharges wastewater to the ground surface, it shall be repaired or replaced by: increasing basal area (if toe leakage occurs), rebuilding the component at the secondary system site (if identified), or removing and replacing biologically clogged absorption and dispersal media and associated piping. If repairs or rebuilding is not possible, a new soil and site evaluation must be performed to locate a suitable replacement area if one has not already been identified. If no replacement area is available, a holding tank may be installed as a last resort replacement POWTS. If the septic system fails and/or is permanently taken out or service, the system snap ue dual luuiicu a"wiv,,,g -� -� •• •••--• Admin. Code abandonment regulations. Requirements include: - All piping to tanks shall be disconnected and abandoned pipe openings sealed. -The contents of all tanks shall be removed and disposed of by a licensed septic professional. - Tanks shall be crushed & filled, or removed. - A septic system abandonment notification shall be submitted to the appropriate local governmental unit. WARNING!/ SEPTIC, PUMP, AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC TANK, PUMP TANK, OR OTHER TREATMENT COMPONENT UNDER ANY CIRCUMSTANCES, DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ALWAYS CONSULT A LICENSED SEPTIC PROFESSIONAL BEFORE DOING ANY WORK. PanpP 7 Maintenance of the GF 10 Filter A time frame in which septic tanks are serviced is set by state and local codes. Although they may be different, most regulatory agencies suggest two to five years. We recommend the GF10 filter be cleaned when the septic tank is normally cleaned and pumped, or as needed. WARNING: If the liquid level in the tank is above the top of the filter, pump the tank prior to removing the filter cartridge. DO NOT USE PLUMBING WHILE FILTER IS REMOVED! 0 CAUTION: USE RUBBER GLOVES WHEN HANDLING FILTERS! DO NOT ALLOW SOLIDS TO FALL INTO FILTER CASE! RECOMMEND RINSING OVER SEPTIC INLET. Step 1: Remove the septic tank cover and pump the tank if necessary to prevent any solids from escaping to the field when the filter is removed. 4;060 Step 2: Pull the filter handle and slide the filter out of the case. C 1 s W Step 3: While holding the filter cartridge over the access opening of the tank, rinse the cartridge off with freshwater. Take care to make sure all solid material falls back into the tank BEST TECHNOLOGY 3 Fairfield Blvd, Wallingford, CT 06492 1-877-765-9565 Fax:203-284-8514 E Step 4: Insert the cartridge back into the case making sure that it is properly aligned and completely inserted into the case. ST. Clzo IUNTY SANITARY SYSTEM File#: OWNERSHIP/ADDRESS FORM Creoted a/toal o�212o21use y Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. OWNER/BUYER INFORMATION Owner/Buyer A"T"af-4 lJOv� Mailing Address i'73tr, C74 Kci 1`11 City/State/Zip t9,vP_R FkCA,5 . VVI � ` 047- Phone Number (required) Email Address (required) 11yt'gl�c ��r�rc- [ valt.o.c opt Parcel Identification Number C74q -lON3 -?,n -oat (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION 1-1 Property Location SE t/4 , Nw' t/4 , Sec. 33 T Ln N RJ* W, Town of Subdivision Plat: — Lot # Z . Certified Survey Map # 1 l 249 Volume 3 1 . Page # 69-- Warranty Deed # (before 2006)Volume . Page # Number of bedrooms 3 Spec house 0 yes 111(no Lot lines identifiable 0 yes 0 no OFFICE USE ONLY New Property Address -�' aA`04d (v (i tion of new address required from Community Development Department for new cantruction) 3o z, z fs ff "tick) (Date) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form a recorded warranty deed from the Register of Deeds Once and a copy of the certified survey map if reference is made in the warranty deed. Community Development Department - Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cdd(asccwt.gnv 1101 Carmichael Road, Hudson, WI 54016 www.sccwigov P^n ORIGINAL Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildrgs in accordance with Comm 85. Wis. Aden Code County Attach compfele site Plan on Paper not less than 8 112 x 11 inches in size. Plan must indude, but not limited to: vertical and harizonlat reference point (BM). direction and Parcel percent slope, scale or dimensions, north arrow. and location and distance to nearest road. Please print all Information. Revlev Peraorgl Informeton you Provide may be used ! secondary Pun �.01(1) C /t'rri lr . n icyA rrI / -/,' jk_ jD�'•tnoa / Data I I. Lot L 1 /4 r W 14 S i if Block # Sbd. Name or CS T a o N R 7 E (o( W RLU• J1°"' F�I (,tr1t' � o r-nona , .,�I � OFFICE City ❑ Village own Nearest Road I I,° T �1 ❑,, New Corsi LwAoin Use: Q•rfasidential / Number of bedrooms -- Code derived design Bow rate S�SO GPD Ewm,tacemenk ❑ Public or commercial - Desr,ribe: Parent material d (,?e'r r"&/ Flood Plan elevation 'hf appkable _ VA- --- ft General comments ommen "d CLL'tJ-P- usE., "r X 6-6.dS-r Cel(COJr.�,6AUr, C7,to5 uJOVer cdSe Oki, .�6 ("7- Bum # ❑Nin'g 2/PitGround surface elev. IN 0 ft. Depth to limiting factor in. Soh Application Role Horizon Depth in. Dominant Color Muses Redox Description Ou. Sz. Cont. Color Torture Structure Gr. Sz. Sh. Consistence Boundary Roots GP 'EfWl 'Eff#2 car L - a In`'1614K 4g, C 0— O O Boring # ❑�Ra+rg n 9Pit Ground surface elev. 7 •S fl. Depth to im[i1g facto_ in. E ism MA • �W�MMMWM 1 - tniwni in = Dvu > sU c "LLV myL and I SS >W < 150 ng1L • Eflkuwt #2 = BOD 130 n#L and TSS < 30 mg4 CST N7 (Please Pried Rae CST Number i I 2 t So O Address valuation Conducted Telephone N rrter 7 s; 7 T i Page 20 Pronpwly Owner V am e-s t r `e`c eN 4 Parcel ID 0 BoM' v ` V * El � ply Ground surface elev. G-1 v 11. Depth to imhq facie -2 0 in. Pape ) of 3 Bonng # ❑ Bcrinp 1:1❑ Pit Ground surface stew. fL Depth to limiting factor in. c.,a nmlratir., RaW FARM Ore- M ❑ BMW Al❑ Bonng ❑ Pit Grand surface slew. ft. Depht to lvnbV lector In Cr.il Arr.irafinn Rain Effluent #1 = BOD, > 30 1220 nVL and TSS >30 < 150 not ' Effluent #2 = BODr 130 rrVL and TSS < 30 ng1L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material m an alternate format, please contact the department at 608-266.3151 or TTY 608-264-8777. stwaew MVMM Page 21 r- . )Pa� - 3 a f 3 (1st tt a �;�r0 w% es Er tyn a r. 3000 Crab. .QM. loo.00 � f1old��+�Ta�.�c 1 U top IF BQX FLrrh�f 9 B.M. 98.y Haase 00Ta.,k �bld, � sd' S / �rwz Ali i fa bl 1 I ,. 40 ' etc c rp f Ar Shoco,% gi i Page 22 — F,1 Wisconsin Department Of(;ommerce PRIVATE SEWAGE SYSTEM County-. St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No, GENERAL INFORMATION (ATTACH TO PERMIT) late Plan ID No 479295 0 Personal information you provide may be used for secondary purposes [Privacy Law, 3,15.04 (1 xm)]. _ • 14 Permit Holder's Name: City Village X Township Pairell Tax No. Freeman, James Pleasant Valley, Town of 024-1043-30-001 CST BM Elev InspBM Etev. BM Description. Section/Town/Range/Map No: Ofl •O fI CA •O Itil CST ew il( 33.28.17.280B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic i� W� Iit7 /� ot Dosing (�M Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. vent to Air Intake ROAD Septic > r UV r 1,, too' 7 ? 3 Dosing f r Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number / S Z 30 - �5 rH Lift Friction Loss 1 System Head . TDH Ft 13.10 n �•so �{1 Facemain Length a. Dia. Z ❑ Dist. to Weh r STATION BS HI FS ELEV. Benchmark D • � p» . D AIL BM Bldg. Sewer /�, p • ZS r SUHt Inlet (A \ ( ' �•QVI- ^� � I SUHt Outlet DtInlet Dt Bottom A 1 ; g27•40i Header/Man. Z- a oxv, Dist. Pipe • ?-r Z. Z9, Z •2- z . Z4' r �•`�{ Bot. System z•Qz f Final Grade L-V. (( %ist 64 R." L4v>,errz4 t><w Ia�Ea BvA to r OUM. H0.7VRr11VIY OTOI CM H Width r DIMENSIONS Q' Length r No. Of1Sieeehas �•25 3)14 PIT DIMENSIONS No Of PIS Inside Dia. Liquid SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKEISTREAM LEACH[ CHAMBER O UNIT Ma urer Type Of S�y�st�e�rrr0�y�/� P _ 1/ y I cv / 51 -� (-i Nwnber ula I Kltsu uUN srs l rM f .-T)i .LC .— _...,U _ _ — .._J-- 1.4 Y I We-Npilsollp t to I /1, r 117 Distri bulion I /� u / Pipe($) x Hole Size u x Spacing Vent to Air Intake Largth� Dia Length l Dia Spacing 3 z 5UIL COVER or P.A.... q; fe•na flnty .. U... ..d n, Anlu Depth Over Depth Over xx Depth of xx Seeded/Sodded Mulched Bad/Trench Center Bedrrrench Edges T soil op I Yes .rI No T 1 r Yes L NO COMMENTS: (Include code discrepencies, persons present, etc.) In(�3`peecctiioeon`#11 +(A+�•+ Inspection #2: ->•- _ Location: 1736 County Road M River Falls,, WI 54022 [SE 11/_4•N�W--1/4 33 T213N fi17W) /Hates IPof Pa I No: 33.28.17.2808 1.) Alt BM Description = �4-' bS� Oosou vp.& 0' 4,4 "'^JIMA, � a 2.) Bldg sewer length = 3 3 - amountof cover Plan revision Required? .:, Yes ND - - - Use other side for additional information. SBD-6710 (R.3197) Date hwepdoes S gfadue Ce". No. Safety ud Buildings Division county 201 ington Ave., P.O. Box 7162 ST. CROIX iseonsin 3ot, Wl 53707 - 7162 Sanitary it Number (Lobe riled in by Co.) 608)266-3151 4f441 Department of Commerce Sanitary Permit A Wis. Adm. Code, at•tp[��' F'1 State Plan LD. Number C1150740 '(-R giVS. /A• •) In accord with Comm 83..21. may be used for scoondary puepo Ili ormatim yau�prOvltld`F� . sl5.04(lXm) Pmltxd AAd[4li� erenl than mating address) 1v (:. 'III .Fi RIVER FALLS, WI 54022 1. Application Information -Please Print All Informs S7` Property ONING Owner's Name OFFIt;E Parcel to 1.d-A�- \ Blue" 024-1043-30-001 2806i JAMESFREEMAN Property Owner's Mailing Address Property location 83 170TH STREET SE NW 33 y4 v4 sediat City, State Zip Code Phone Number RIVER FALLS, WI 54022 715/425-9010 28 17ccueleme) T Ni ✓ II. Type of Building (check all that apply) Subdivision Name CSM Num N/A 1 or 2 Famity Dwelling - Number of Bcdsoerns 3 Public/Co mmial-Desoribe Use v /J s.w({,t? ❑CiiyJ:1Vi1Lge Elrownahip cf PLEASANT ❑ State 0wnd- Deroribe Use 1I1L Type of Permit: (Check only one box on Line A. Complete line B if applicable) A. ❑ New System 0 Repla =t System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. en ❑ Permit Renewal ❑ Permit Revisim ❑ Change of ❑ Permit Transfer to New List Previrms !'omit Number and Dale food Before &pirntion Plumber 0%vnar IV. Typeof POVVTS S teen: Check all that apply) .2 = ❑ Non -Pressurized in -Ground ❑ Mound a 24 in. of suitable am 0 Mamd < 24 in. of suitable soil ❑ A[ -Grade ❑ Single Pus Sand Filter ❑ Constructed Welland ❑ Pmourizod In -Ground ❑ Holding Tank C3 Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Send Filter ❑ RecirculatuillSyntlicticMadiaFilter ❑ Leachm Chamber 1313ripLine ❑ Grevcl4=s Pie ❑ Other(er lain) V. Distiersalfrreatment Area Information: — •0 Design Flow (gpd) Design Sal Applicetim Rate(gpdaf) Dispersal Ares Required (sf) Dispersal Arm Propaed (■ System Elevation 450 1 450 450 1 97.83 Vl. Tank info Capacity in Total Number Menufadurer Prefab Site Steel Fiber Plastic Galkxu Gallons ofUnits lJ�,�alja� _1Vp crate Cootruad Glass New 'far" Tw*s -Ct $epiicorHo1drgTar* 1000 11000 1 WIESER CONCRETE X Aerobe Tres mee Unit Dosing Clamber 600 1600 1 WIESER CONCRETE X Vll. Responsibility Statement- 1, tba undersigned, assume responsibility for lntdladom of the PORTS shown m the apachad plans. Phrmber's Name (Print) P '■ Signature MPIMPRS Number Business Phone Number BENNIE HELGESON 220292 7151772-3278 Plumber's Address (Street, City. Stove, p ) W1229 770TH AVENUE, SPRING VALLEY, WI 54767 Vlll. Coun /De artment Use Only r� let APpiot'ed ❑ ed Sanitary Permed Fee includes GrasndwaterZg e Issued suing eat Signature (No Stamp) ch Surarge Fee) •- �� ❑ Ream for ial J I?( Conditions r ppro 3 ` � _ r g 0 , / SYSTEM OWNER: ) (�CDLL vim— 1 Septic tank, effluent fliter and 6a ctic dispersal cell must all be serviced / maintained as per management plan provided hh• nh•m' , 2. All setback requirements must be nt, -•. edioJ as per applicable codefordinance-- SYSTEM OWNER: 1 Se tic aWCUITTMIsrarl as per management plan provided by plumber. 2. All setback requirements must be maintained SBD-6398 (R. 01/03) as per applicable codelordinances. Safety and Buildings Division Canty M � iscvnsin 201 ngton Ave., P.O. Box 7162 son, WI 53707 - 7162 ST. CROIX Sanitary Plumit Number (to be idled in by Co.) De artment of Commerce (608)266.3151 41 2pr Sanitary Permit A In t �r�FF ft'',,CR� Ff,_'r stab Plan I.D. Number C1150740 � -rR gfVS /A. socord with Comm 33.21, Wis. Adm. Code, ormUion you prl1�'{ed'� • maybe used for secondary purposes , s 15.04(1xm) /lit Pfy�cd Add[ga(�f #Mwcn, titan mailing address) 1T36G.T.hI M' RIVER FALLS, WI54022 L Application Information -Please Print An Warms S7. Property Owsrds NameONI NG OFF/U1v Parxl M ].arl�- BtooYa JAMES FREEMAN L`� 024-1043-30-001 (, 2805) Property Owners Mailing Address Property Loostion 83170TH STREET SE V.,NW :.Section 33 City, stow Zip Code Phone Number RIVER FALLS, WI 1 54022 1 715/425-9010 28 17(ciroke) T — N' eav IL Type of Building (check an that apply) I al or 2 Family Dwelling -Number of Bedrooms 3 Subdivision Nome CSM Nmn ❑ Pab6Describe Use / N/A Pa.. / ❑ state Owned- Describe use ❑City j3Village E}rawnship of PLEASANT b III. Type of Permit: (Check only sate box on litre A. C®plete line B if applicable) A.. 0 New system 8 Repleasnwd System 0 TmtlmemlHolding Tank Replacement Only 17 Other Modifieolion to Elating system R. 0 Permit Renewal 0 PermitRavision 0 Change of ❑ Permit Transfer to New list Previous Permit Number and Date Issued Before Expiration Plumbs Owner IV. Type of POWI'S System: Check all that a = 0 Non -Pressurized in -Ground ❑ mound a 74 in. of suitable 0 mo and <?4 in of suitsblesal ❑ A`r4kade 0 Single Pass said Filter 0 Constmocil Wationd 0 Premurimd b-Ground (3 Hiding Tank 0 Peat Filter 13 Aerobic Treatment unit 0 Recirculating sand Filter 13 Raoirmtsting sgrithetto Media Filter 0i.4whiagchamber apnpLu., a gravel-lae 0 Other ( ) V. DistieraWrreatment Area Information; ,Q Deign Flow (gpd) Design Sail Application RaWedsf) Dispersal Amer Rexprvcd (tQ Teri aaat Asses Proposed (20 System Elevation 450 1 450 450 97.83 1 VI. Tank Wo Capacity in Total Number MaaaSdurer Prefab site Stud Fiber Plastic gallons GaOms of Units w/zabR4 A _100� ewe Comtreaw aim New Taub I ad -tins Taob Sep; er adding Tart 1000 1000 1 WIESER CONCRETE X Asrotio TnYmao[ Unit °OYesClim"°r 600 1 1600 1 WIESER CONCRETE X VIL Responsibility Statement- 1, the smdarsigued, sis unra reapasip[Mity for hotaWtim, of the POWPa shown on the atheMd Phrmbees Name (Print) P 'a Signature MPMM Number Business Phone Number BENNIE HELGESON 220292 7151772-3278 Phumbees Address (strcet, City, state, p ) W1229 770TH AVENUE, SPRING VALLEY, Wl 54767 Corer /De artinent Use Only rcVIlL Va Approved ❑ ed Somtary Pesmd Fee(iooi ud= Gto ndwaler Date bsaod Ding SigrWwe (No Stamp) ID Rr�son far dal Surcharge �J IDL Conditions .pro SYSTEM OWNER: 1 Septic tank, effluent fllter and C T dispersal cell must all be serviced / maintained as per management plan provided br, altom!:r•o 2. All setback requirements must ben .-,:.y6-,r;d as per applicable codelordinances. SYSTEM OWNER: 1 Septic tank- affluontfiligirgilri as per management plan provided by plumber. 2. All setback requirements must be maintained SBD-6398 (R- 01/03) as per applicable codefordinances. • � (�I o� �ac h L�cLN�er; Saw�es �re�w.ar. TOP o� �e xis •� RM. it cf 5ckic l" 4 4 Ekc-fp s S COPY EK (S7M 3CW 6a! tidl�iwq QKk ��P�d � FilleQ /000/600 6o� sephVALor 7-L&t u�d�r Arwcu� ",,� 1AW UNAZ6WNr ,a .�r�couN�� NO. 645484 STME SANITARY PERMIT 1�36 Ci kAMWk[�iSS{XA{, PREVIOUS NO. 4/7= .ZQ! OWNERNw /����Kj PLUMBER TOWN OF_V SEC 33 ,T EXPIRES SUBDIVISION 145.135 (2) NISCONSIN STATUTES ra)w'$e purpose of the unitary permit is to allow Installation of the private sewage system described In the permit (b) The approval of the unitary permit is based on regulations In force on the date of approval. (c) The sanitary permit is valid and may be renewed for a specified period. (d) Changed regulations will not Impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations In force at the time renewal is sought, and that changed regulation may impede renewal. (1) The sanitary permit Is transferable. History: 1977 e. 168; 1979 c. 34,221; 1981 c. 314 Note: if you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. ISSUING OFFICER -DATE SD 00? Z f LI UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (RI 1/20) State Bar of Wisconsin Form 5-2003 PERSONAL REPRESENTATIVE'S DEED THIS DEED, made between Amy E. Freeman as Personal Representative of the estate of James S. FMSM a single person ('Decedent"), ("Grantor," whether one or more), and Anthony F. Novak and Oanh Constance Thai, husband and wife as survivorshin marital nronetty (`Grantee,' whether one or more). Grantor *my" to Grantee, without waneaty, the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County. State of Wisconsin ("Property") (if more space is needed, please attach addendum): Lot 2 of Certified Survey Map recorded in Volume 31. Page 6959, as Document No. 1129974, located in part of the Southwest Quarter of the Northwest Quarter and part of the Southeast Quarter of the Northwest Quarter of Section 33, Township 28 North, Range 17 West, Town of Pleasant Valley, St. Crony County, Wisconsin, 1132077 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 06/10/2021 08:04 AM EXEMPT*: REC FEE 30.00 TRANS FEE 265.50 PAGES: 1 **The above recording information verifies that this document has been electronically recorded & returned to the submitter Raoading Ara Name rod Rome Addle L� A. Baalw Attorney at Laws 219 N. Main trhaet River F" WI 54022 bt 2171021-05485 Part Of lag•1t),Iq:: oar. t o�� do ag: ma• to+±As ono Patoal Idendfinlion Number (P" Thin a net hammeead loopsry. Cs) Ca not) Personal Representative by this Deed does convey to Grantee all of the estate and interest in the Property which Deaoedent had immediately prior to Decedent's death, and all of the estate and interest in the Property which the Personal Representative has since acquired. Dated 6 [ LI / a PERSONAL REPRESENTATIVE: AUTHENTICATION ACKNOWLEDGMENT TITLE: MEMBER authorized by THIS INSTRUMENT DRAI-M BY: - Leo A. Beslar Rodli Beskar Neuhaus Munn dt Pletcher S.C., 219 N. Main Street River Falls, WI 54022 STATE F WISCONSIN ) W. COUNTY ) Personally came before me on rp /� 1 / Z / the above•.namsd Amu G wn to be the person(s) who executed the foregoing and acknowledged the same. Notary Public, State of Wisconsin/Z �✓ My Commission (is permanent) (expires: (Slpatwee may be nudiendcoW or aelmo.dedged. Both are not neusoory.) NOTF- THIS IS A STANDARD FORhL ANY MODIFICATIONS TO THIS FORM SHOUIM BE CLEARLY WnwnFIED. PERSONAL REPRESENTATIVE'S DEED O 2003 STATE BAR OF WISCONSW FORM NO.5-2003 " Typo nano below msoatuam St. Croix County 1132077 Page 1 of 1 C� J 1129974 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI Certified RECEIVED FOR RECORD Survey Map OS/13/2021 11:46 AM Amy E. Freeman, Joseph D. Stavinoha and CERTIFIED SURVEY MAP VOLUME:31 James S. Freeman Estate PAGE: 6959 REC FEE: 30.00 Par' of the Southwest t/e of the Northwest t/e and pail of the PAGES: 2 Southeast /. of the Northwest tX of Section 33, Township 28 North, Range 17 West, Town of Pleasant Valley, St. Croix County, Wisconsin, including part of Lot 1 of that Certified Survey Map recorded in Volume 28, Page 6371, Document No. 1050836 of St. Croix County Certified Survey Maps. N 59•se•25w e0s.00• R s 90.005ev3ow.ne Lot C_S.M. Vol. ! Pa e 9 4 I 2� I I N OQ'10'18'E 80d.0p• R(N 00.06'00'EJ I A Z) r'► € l i I S0.61' R(IO.007 757.36' H N � tin 1{ I I nl f�• � -a � v I � '�—i N I I M o I a to K 2 I I" sooro9s9wz.00 #q Nmti m; C I I A 4 a �► 7'.. IS U o lay Img of I�.. 0 0 A tail l I u �--ON la �W g d _ Y Ot�Ct IC I----- -------------- N 7. a N i RAM c3 _ 00.0911 E 11 ' 1T19 __—_ _' A S�S.•,.. WA1.1�5.yJ�` ,2jyl I `fir C`S 0� rn N �yy��NALLPNV"�� IzI I `° Hz:�`o�? 7j�gpunw�tta�•a� pS \ >ps 18 0 X' 2 z Dated: March 21, 2021 I�•c I I �d=s r pa oo I I I I m Zve _x� N 00.OD'4•E 2614.71' I Cenrer9ne _ 4 � On.+e+r s o0•o9•+1w � it ju7.T en, o•, 1670.1V tys to une S 00.09'11'W 926.21' gamg, s69.69ww szlo.or I Outlo�_C Esat 114 Comer See. 33. UNPLATTED LANDS j V°I_25a LOA 5909 _= T26N,R17w A � (aMtlteell Ne/1 FOUndf N 69.56751N taw 9/• R(N 90'00.00YY ene S 69.5677W Sheet 1 of 2 Sheets St. Croix County 1129974 Page 1 of 2