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HomeMy WebLinkAbout004-1027-50-100W iscor~in Department of Comr,~wce Safety and Building Division • PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) 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 Gunderson, Jeremiah Cad ,Town of CST BM Elev: Insp. BM Elev: BM Description: ~~ ~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ ~~'~ ~~~ Dosing d Holding TANK SETBACK INFORMATION TANK TO P/ WELL BLD Vent to Air Intake ROAD Septic er,,~ ~ , 1/~ / , ~ ~! ~Sb' Dosing ~ ~ , ii ~ /v ~ 5~1) r! Aeration Holding PUMP/SIPHON INFORMATION /~,Y Manufacturer t ~ mand GPM Model. Number ~ j~ ~ ~~' 1,~~ TDH Lift ~ ~ `~ Frictiozn L~~ System H~d Z7 TDH r,~t Forcemain Length i ~iS Dia. ~~ Z Dist. to well SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 463473 0 State Plan ID No: Parcel Tax No: 004-1027-50-100 Section/Town/Range/Map No: 12.28.15.183A10 STATION BS HI ~: FS ELEV. Benchmark 3. 9 ~t~ / ~~ Alt. BM Bldg. Sewer ~ ` ` ~ ~ + ~• O SUHt Inlet ~~C 7 92 • ~ SUHt Outlet ~ ~ Dt Inlet ~ Dt Bottom 5. ~- Header/Man. I / / a' ` ' Dist. Pipe ~I ,~ ~~, Bot. System ~1 a ~ • ~~ Final Grade 3 IS ~~Z ~ St Cover ~~' ~ ~a~,l ~ ` ~` '-7! BED/TRENCH DIMENSIONS Width / 'Y.~ Length > ~~ No. Of nche ~ PIT DIMENSIONS ~,~ No. Of Pits `~ Inside Dia. ~ Liquid Depth ~ SETBACK O SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer. ~ INFORMATI N Type~ybst`e~m: // // ' ~ ! ~~~ A TLI~._ ~~ UNIT Model Number: i~ I~ISTRIRIITInN SYSTEM ~L.o~4. Header/Manifold ~/ / Length_~ Dia ~ Distribution ~, + ~ Pi e s )) Q~ Length ~~0 • " Dia ~ /~ Spacing~~ x Hole Size ` ~ ~ x Hole Spacing ~ ~ • ~ Vent to Air Intake` ~~ 7 cti-~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only ~""' Depth Over ~ Depth Over xx Depth of xx Seeded/Sod ed xx Mulched Bed/Trench Center / + / _ G ~O / Bed/Trench Edges ~ Topsoil ~ ~ ~ es ~.~ No es I _ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ / z~/ 05 Inspection #2: / / Location: 3225 50th Aveque Wilson(,,,W, 154027 (NE 1/4 N lW 1/4 12 T28N R15W) NA Lot 1 P~~ , d °` ~ Parce No: 12.28.15.183A10 1.) Alt BM Description = J+~ ~"'J eJ`"" ~h,o~:,~ Ohm. ~ C"tO ~,~ 2.) Bldg sewer length = , G/ ~ -T~ ~ ~~ ~ _ ~ J ~ ~ ~~~ ~~~ ~ ~~ / -amount of cover = c/ b ~~, CaL.~ f/~ Plan revision Required? ,1, Yes No ~/~ ~l ~i~ ~ r„ ~~ S Use other side for additionai information. ~ T L.. ~i _._i I_-- _ - -' _u+_i___ ~__l.____ . Date Insepctor's Si ature Cert. No. SBD-6710 (R.3/97) Safety tags Division Cu"~' ~,~ C ~ ~ l 201 W. Wash' ., P. . [3ox 71G2 sanNa~r P«~it N rto a~ n ip~i~ 3 Co.) ~~ ~~ 3 . ! Q~ ®~ R ~ . n , ~~ E Oe artment of Commerce I.D. umbu ~~ # Sanitary Permit Application ~ ~ ~ ~ ~ ~~^ .TES . in accord with Cantu 83.21, Wis. Adm. Code, pentaral inAxtratierr Y~ I .~ may be used for secondary proposes Privacy Law. st5.04(ixm) ~~ ~ Add (itdiflbe'cnt them anilit-g address) ~~ I/ i. Applieatian imtormratiae -Please Print AM Iwfiraarttioo ZpN1N~ ~ N,~ 2- S~ S~° ~I/ ~ # Let rt Black d Property Ovmer's Namc Properly Owner's Mailing Address *~ Property 1'0adtion ,'t ~ ~ ! /~ ~ %., Beefiest G ~/., l' tJ . ~G f / C)i /Sane ~v I Zip Code PAn°"e Number D. T~pe of Baildin~ (chock all that aPMY) ~ t7~ (~ S~ SM N ~i'1 or2FamiiyDwdiiag-Nwnb~xofBedrooms ~63Jt0 ~ ~V • ~u~o ^ PabiiclComrtrencial -Describe Use ~~ ^City ^Viliage ~I'owrghip of ^ Bute Owned -Describe Use 1D. Trpe of Permit: (Chuck ody one bat om Stae A. Cotmpkte line B K applicable) - • A' w System ^ Rephrcernent S'yatarr O TresnnarttNolding Tank Replexxrrtdtt tbrty ^ Other Modification to Existing System Lint Peevious !'emti- Nrarrber and Date bauod 13. ^ Permit Reenwvai ^ Permit Revision ^ Change of ^ Permit Ttaufer to Ncw Before Expiration ~~ O`er ~ `~ l ( C N. T of POWTS S Check err tkart X ~ t ^ ^ Non -Pressurixed In~Gtound ^ Mornd >_ 24 is of suitable aoii Maard < 24 in. of xrita6le so0 ^ At-Grade ^ Slagle Pass Saud Filter Cormtnwted Wetland ^ Pressuriz7ed hNGrarnd ^ Iioldiag Tardc ^ Peat Filter ^ Aerobic Trarptrart Unit ^ Recirariming Sand Fiber ^ Recircrrlati Syatnuie Media Filter ^ Leetch' Chemtber ^ "Line ^ t3ravel-less P' ^ Otlter V. al/I'reatttmnt Area Iafot~etiea: Desisn Flow ttipd) ~!SA Sal Appticatian ~ Itequircd (sf) Disp~si (~ SYm~ ~~ /~ ~ " 5 U >, I~ A . Vi. Tarok lafo Capacity a Ttnal Number Manutacturcr Rdab Site Stee! Fiber Plaslic Galtorrs Gallons atUnits Carrcrete Constnreted Grass New Teaks 7aab Septic or Holdh~ Teak CTG G I.J r L S ~ /Z, Amd~ieSaottaa . powgt Char6er ~ ~! ~ t ~/ VII. 'biiky Statement-1. tpe aearare fir itpfalhtitm et1Ne POWTS aYotna oa the attached iNtarrber's Name Prim) a S' .MPJIViPRS Number Business Phone Number Plumber's Address rStrem, Ci , Spite. Zi ) , Vpl. Csum trtmemt the Approved ^ Sanilmy Permit Fee (i odes Gramdwater Date Issued Issuing gent Si ~) Sraelrfuge Fee) ZS~. 3 D Reasatfor IX. e:oerdhioms f Ap n ~ 3~ `"'~ ~"`"'"""" C~r~ SYSTEM OWNER: 1 Septic tank, effluent filter and ~~~ -~ $ ., ~ ~ dispersal cell must all be serviced (maintained ---- ~- as per management plan provided by plumber. 1 2. All setback requirements must be maintained ' as per applicable code/ordinances. W~-~.n-t~a...6..Mdr Ar~Cti ~ P~~ 1W me ~ s4/ wr .wc s~a.ww w ~.. ~. ••~• 31~ fD ~"+~ SBD-6398 (R. 41/U3) ,; n .. S~~ ~~~ ~~4~I % - ...wq..~,~, u ~ '~i ~ ~ ~~ ~~us ~ ~ '.. ~ ~ , p~ ~ ~3 q~. ~~ .~ ~~ ,~ ~~ ~/ouse~ .... .. q ~..,.:... ' x r 1 ~ I ~~ ~ ~ 6 „ ~ .n ,~,~ r `~~' . tob~ `~s~ ,r ~' r ~I ~ v w •` . '~ toJ? ~~ .~ ~ ~ ~~ Nv~ sEC, ia,T29T~J~RI~o''~I ~. i . }~ ~ ~ ~t~~ r,,. ~~ q G ~ o "'~ c~ commerce.wi.gov ^ ^ ~sconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary May 06, 2005 CUST ID No.223475 JOE STANG STANG PLUMBING & ELECTRIC PO BOX 263 WOODVILLE WI 54028 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/06/2007 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 SITE: Jeremiah Gunderson 50th Avenue Town of Cady St Croix County NE1/4, NW1/4, S12, T29N, R16W Identification Numbers Transaction ID No. 1134654 Site ID No. 698132 Please refer to both-identification numbers, above, in all cones ondence with the a enc. FOR: Description: Proposed Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1017214 Maintenance required; 450 GPD Flow rate; 12 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version2.0, SBD-10706-P (N.O1/O1); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the approved plans, and the "Mound Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD-10691-P(N.O1/O1). • The pressure network is to be constructed in accordance with publications SBD-10706-P(NO1/O1) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems -Version 2.0" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81)" • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. P.O.W.T.S. Conditionally APPROVED JOE STANG Page 2 5/6/2005 • Comm 83.22(7) - A cogy of the approvedplans, specifications and this letter shall be on-site during construction and oven to inspection by authorized representatives of the Department which mawinclude local inspectors. Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) -The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Gerard M. Swim POWTS Plan Reviewer -Integrated Services (608)-789-7892, Mon. -Fri. 7:30 am to 4:15 pm jswim@commerce.state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code:.7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 °~ ~~y~` ~.,~ MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PA~3E Project Name: Owner's Name: Owner's Address: Legal Description: Township: County: Subdivision Name: Lot Number: Parcel I.D. Number: Plan Transaction No.: Jeremiah Gunderson 3 Bedroom Residual Mound Jeremiah Gunderson P.O. Box 171 Woodville, Wisc. 54028 NE 1/4 NW 1/4 S12 T29 NR 16 W Cady St. Criox Block Number: 004-1027-50-000, ID# 12.28.15.183 Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Site Plan Page 9 Soil Evalation Resort RECEIV~~ MAY 0 2 2005 SAFEN & g~I~~INGS Designer. Joe Stang License Number: 223475 Date: 04/2 /05 Phone Number: 5715) 684-5166 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SOB-10681-P (N. 01/01), and SSWMP Publication 8.6 Design of Pressure Distribution Networks for ST-SAS (01!81) DEPARTMENT OF COMMERCE Version 4.01 (R. 09/04) DIVIS-ON O FETY ND BUItDiNGS page 1 of 9 SEE CORRES DENCE Mound and Pressure Distribu#ion Component Design Design Worksheet (r or c) R Residential or Commercial Design 300.00 Estimated Wastewater Flow (gpd) 1.60 Peaking Factor (e.g. 1.5 = 150°~6) 450.00 Design Flow (gpd) 9.00 Site Slope (°/a) 88.64 Contour Line Elevation (ft) 12.00 Depth to Limiting Factor (in) O.~iO In-situ Soil Application Rate (gpd/ft2) Note: Sand 8p (I)) ~ aassume a Table 8:344.3 Ineitu sob treatment for fecal of c~ 36 inches. Dlstribultian Cell tM'or'matlon 75.00 Dispersal Cell Length Along Contour {ft) = 8.00 Cell Width (ft) 1.00 Disperse( Cell Design Loading Rate (gpd/ft2) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest 'nt Pressure Disribution Irrtocrnaition (c ore) c Center or End Manifold 3.00 Lateral Spacing (ft) 4 Numtaer of Laterals 0.188 Orifice Diameter (in) (e.g. 0.25) 3.00 Es (mated Orifsce Spacing (ft) 2.00 Forcemain 4iameter (in) 140.00 Farcemain Length (ft) $7.10 Pump Tank Elevation (ft) 3.25 system Head (ft) x 1.3 13.04 Vertical Lift (ft) 2.96 Friction Loss (ft) 19.25 Total Dynamic Head (ft) ~.a€teral Diameter $elevtion in. dia. o ions choice 0.75 1,00 1.25 x x 1.50 x x.0a x 3.00 x Tnaatiment Tank Irrtannatiaa 1000.00 Se is Tank Capacity (gaf) Wieser Manufacturer in the distnbution Y network?' Enter Y or N If N above, enter the elevation ft of the highest point. 9.38 ft~lorifice Does the foroemain drain badc7 Y Enter Y or N 22.84 Forcemain Drainbadc (gaq 48.90 5x Void VoWme (gap 89.73 Minimum Dose Volume (gap 31.48 System Demand (gpm) Manifold Diameter Selection in. dia~ o ions choice 1.25 x 1.50 x x 2.00 3.00 Must select a manifold diameter Gaflans/lnch Calculator (optional) 850.00 Tatai Tank Capacity (gap 42.00 Total Working Liquid Depth (in) 15.48 gaUrn (enter result in cell 849) Dose Tank lnfornnation Effluent Fitter lnfotmation 850.00 Dose Tank Capacity (gat) Zabel Filter Manufacturer 15.48 Dose Tank Volume (gaUin) A100 Filter Model Number Vt~eser. Manufacturer Project: Jeremiah Gunderson $ Bnlroam Mound Page 2 of ~' Z0d =QI ~bE:bT 50-90-50 Mound Plan View i- 1_ ------------------------------------- 1l ~ ~ B Observation Pipe 0 ' K ti~•.•S ~ti1.-•~•,•.,•,ti,ti, ~~~L,~L,~L,••~~L ~•.~L~~~ti ~•~•.~5~~ti~'L~•. ~•~5~~'. ~".. •~.~:•. •'r r, r•r•r • r r• • r.r•r•:• r•: •r•. r• ~•. • r•:•r•r•. r•. •; r•: B i-.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 A 6.00 ft B 75.00 ft D 24.00 in 1 L - Mound Component Dimensions E 30.48 in F 9.50 in G 0.50 ft H 1.00 ft K 12.19 ft z 15.75 ft L 99.37 ft J 7.78 ft W 29.52 ft 450.00 (ftz) Dispersal Cell Area 6.00 (gpd/ft) Linear Loading Rate 1630.99 (ft2) Basal Area Available 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 102.43 (ft) .tff.. 100.64 (ft) --• F Dispersal Cell Elevation rr ~ .. ~ H rrrfrrrr 2 rrirrri G rri{E rim{ Dispersal Ceti 101.14 (ft) Lateral Invert ~p ~ t .• .. ... ~.. .. ... ., ... 9.0 % Site Slope Shading Key 10 -Topsoil Cap © rrrii Subsoil Cap ' • ~ • ASTM C33 Sand ® Tilled Layer a r:rtir: Aggregate a 1 !5 ft ~ ~ ~° ~ 0.5 ft ~ ° Dispersal Celi ri i~erei A 98.64 (ft) Contour Elevation Geotextile Fabrie Cover . See lateral details on Page 4 for number, size, and spacing of laterals. F Laterals are equally spaced from the distribution calf's centerline in the ` distribution cell (AxB). -T -} _~ -• Project: Jeremiah Gunderson 3 Bedroom Residual Mound Page 3 of 9 05-06-05 14:30 ID= Centelr Connection k.ateral Layout Daigram Foroe math oonneoNGn vla lwe a Dross to manliald at any p~oiltt. l~ •^ 7urn-up+wibsNvatvsor ~-x~ elaanoutpFuq hblQS d-ilied an the tnoee©m of the lodrral. Number of Laterals Lateral Diameter Lateral Length (P) Lateral Spacing (S) Lateral lrlaw Rate Syskem Flow Rate Total Dynamic Head page Tank Information Electrtcel as per NI:C 3Q0 snd ---- ~.~... Comm 18.26 WAG Disconnect Orifice Diameter Orifice SpBang (~ orifices per Lateral Orifices Density Manifold Length Manifold Diameter >'orcemain Velocity t.terals ~r~ ia~a~ _ -- .AIL t.~teryls 6 fo-ae nwin of PYC Soh SIG per CL~+WI 7at-If f14.30~ 'rank Camponers is prbpcrlyy vertled Wieser C adt 650.00 Volume 15.48 Manufacturer t3allon5 gal/inch A B C D Dimension Inches Gallons A 23.48 363.55 B 2.00 30.96 c 4.5a 6x,73 D 12.00 185.76 Total 41.99 650.00 Alarm Manuafacturer SdE-F~hambus Controls Alarm Mod61 Number Tank Aleck 1 Pump Manufacturer Goulds Pump Model Number 3887 EP05 ~ ~~ Pump Must Deliver 31.46 gpm at 19.25 ft TDN Protect: Jeremiah Gunderson 3 Bndraom Mound Loctdng aovar vrltlt wamtng Label end kx~dng device and sled 4 in. min. E--- Atten~a6e outlet location Forcen~ain diameter ~ 2 in. weep hole ar erai- elphondevice ~Dase tank ekvatfon 87.10 Palge 4 of 7 P03 Mou d Sv$tem, MaiQ~enance aid Operatior~,Sgeciflcations Service Provider's Name Joe Stang ~ Phone 715-684-5166 POWTS Regulator's Name St. Criox Cou Zonin Phone 715-368-4680 Design Fiow -Peak 450 gpd Maximum influent Particle Size 1/8 in Estimated Flow -Average 300 gpd Maximum BOD5 220 mglL Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 ftz Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform ~10E4 cfu/100 mL S®rvice Freagsncv Septic and Pump Tank Effluent Filter: Pump and Controls Alarm Pressure System Mound Other Ins ct and/or service once eve 3 ears Should ins and clean at least once eve 3 ears Test once eve 3 ears Should test monthl Laterals should be flushed and ressure tested eve 1.5 ears tns for ponding and see a once eve 3 ears 1. Observation pipes are slatted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate confomns to Comm 84.30 (6){i), Wis. Adm. Code. 3. AI! gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished • ............. ............... Grade ~ ""' 6-8" Diameter Lawn ~, Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Jeremiah Gunderson 3 Bedroom Residual Mound Page 5 of 9 Mound System Management Plan Pursuant to Comm 63.54, Wis. Adm. Cade Thb system shall be operated in accordance with Comm82-84 Wis. Adm. Code, and shall maintained in accordance wRh its' component manuals [SBD-10891-P {N.01 /01) and SSWMP Publication 9.6 (01 /81)J and local or state rubs pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump ink since dangerous gases maybe present tixrt coukf cxarse death. Septic and pump tank aba~Ortment shall be in acxordarae with Comm 83.33. Wb. Adm. Code when the tania are no bnger used ~ POWTS comporx3nts. ~b ~ PAP tank manhole risers, access risers and cavern should be inspected for water tighbtess and soundness. Access used for service and asse~rrrent shah be sealed watertight upon the completion of service. Any opening deemed unsound, dee, or subjecx to failuro must be replaced. Exposed access openings greater tixet S-inches in diameter shah be seamed by an effective loddng devke to prevent accidental or urrauN~orized entry into a tank or component. ,f3entic Tank The septic tank shah be mairained by an individual certified to service septic tanks under s. 281.48. Stets. The corrterrts of the septic tank shah be dbposed of in accrardance wAh NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shah be at least arxx3 every 3 yearo by inspection. The outlct flfb~' shah be cleaned ~ necessary to ensure proper openfort. The filter cartridge should not be rorraved unless provisions ere node to retain solids in the ~rtk that may sough o8 the fNter wren removed front Its enclosure. If the flitar b equipped with an alarm. the flKer shall be serviced if the abrm b activated coctinuousgr. IrttermltteM filter alarms may indicate surge flaws or an irrtperWing continuous alarm. The septic tank shah F-ave its tar-tertts renrotred when the volume of sludge and scum In the tank exceeds 1/3 the Nquid vogrrrre ~ the tardc. If the cortter>ts of the tank aro not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service Heads to be pertontted to maintain bss than ma>dmum scum and sludge accumuletiat in the tank. The addition of biobgir~l or chemical additives to enhance septic tank pertomranoe b gerterolly not required. However, if such products are used they shah be approved for septic tank use by the Departrtrent of Commerce. Tank The Pump (dosing) tank shah be inspected at least once every 3 y~ro. All switches, aborts, and pumps shah be tested ro verify proper operation. If an effltrerrt filter b installed within the tank it shell be inspected and serviced as necxresary. fNa~und and Pressure Disfxibutlon Strstem No trees or shrubs should be pbnted on the mound. Plantings may be made around the naund's perimeter, and the mound shah be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Tretflc (other than for vegetative maintenance) on the mound is not recommended since soil cattpaction may hinder aeration of the infiltrative surface within the mound and arrow compaction in the winter will promote frost pertetratiort. Cokl weather in~allatiorts (October-Febnrary) dictate that the mound be heavNy mukftsd as protection from freezing. influent quality into the mound system may rat exceed 220 mg/t BODg,150 mg/L TSS, artd 30 mg/L FOG lbr septic tank effluent or 30 mgll. BODS, 30 mg/t. TSS,10 mgll. FOG, and 10` dull tR1 ml. for highly frosted effluent. Influent flow may rat exceed maximum deem fkrw sparffied fn the permit for this instaibtiort. The pree~xe distributbrt system b provided with a flushing point at the end of each bteral, and lt b recommended that each lateral be flushed of aaxrrt-ubted solids at least once every 18 months. When a pressure test is performed it should be rampared to the initial test when the system was irtstalbd to determine if orifice clogging has occurred and M orifroe cteaning b required to mairrtaht equal distribution witltin the dispersal cell. Observaoiat pipes within the dspersal ceN shah be checked for effluent pending. Pondhtg btrels shah be reported to the owner, and any levels above 6 iraltes considered as an impertc~tg hydraulic failure requking addftional, more frequent monftoring. CoMinaancv Plan if the septic tank or any of fls components become defective the tank or component shah be repaired or replaced to keep the system fn proper operating corrdltbn. If the dosing tank. pump, Pump cgntrob, alarm or related wiling becomes defect~e tits defective component(s) shah be irrmlrediedey repaired or replaced with a component of the same or equal performance. If tire mound component Fails to accept wastewater or begins to discharge wastewater to the ground surface, it WIN be repaired or repaced in its' Present Ioc~tion by inrxaasing bassi arce if toe leakage occurs or by rerraving biobgically clogged absorption end dspersal media, and ratted piping, and replacing saki components ~ deemed rterx~esary b bring the sys~nr irrto proper operating candltbrt. See Page 5 of tills plan for the name and telephone numbs of your kx~l POWTS regulctor and service provider. Project: Jeremiah Gunderson 3 Bedroom Residtial Mound Page 6 of 8 f.` i+t ~~ .~ - ~.r ~, ~ EPQ4 EP05 k~l:,. ,t APPUCAt'tONS ' ~ Wliy submacged to hbh ^ i tRt~b~1': "1'herma- r ~ U and bwer $ _ d ned forthe tae turbine oif tior pias>~c eaolemeA d8si~t for heey/ duy ~brit~tiort and t impnar~ed pet~famanoe. ccMSt~on: heat transfer. ' ~Ei merit systems ~ A6E~CY LIIiT,IMI~ 1@ ~ 8~it~C ar~i . ~~ IMti lyfR- f1Ce. ~• C~daR~i~OslddOO{i1fM M~vy du~,rsttmp tndne Mec-anipt `W~er trar~e~ Clo~iC$Yrilch ad # Moir' Nom: Cast Iron (C&A iisieA model. n~b~ ` ~ pt~set at the factey. iqr BnC heat trenster, erni in "L~" ar "C'.) sue. add dur~b~ty. 'JlT10MS ~ _ rMe~arfTttemtoplestic e~eoa.t~io~t~et~w• _ caroar wNh inte~al handle ark So6ds~ r~~lhl: r°~ : Thenna- flpa~tst~Gdt ah~chmera ~'~; ttwdmum. i~lc`Sem design poi+ds. Ca~Idae~ up to i~O tPM. ~~ ~ r l~rert Sduere~duiy Tatai.heads: up ~ 3i fleet. '' Dirge 1;/~' NP`T, tubed al andw~er resisiatie: • Med oarbort- = t+~a~ylbarerrab~sia~a~ta~~ BtIIItA-11E e~0ltt~s. •'lenRetrd; t#~4°F {40°~ coorrtinuou~ 140°F(6tin6ermi~nt. tra*r~st ter .... ,~..,,_,._,_ __. _._. .. + s series ~ ~T ~ ..~ ~ . _ ~ ~ ~'--'- Fr • t~pt6taOf rurt~. ~ 90 - ~_.~...._..• sc~ .~_ - d~Y+eRhtxddamr~sin e ~. ;.~.._.. .... ~ amnpt~nerds. ~ ~ ~ ~ ,~ • EP04 ptt~e~ 0 4 HP, u'~ .. _ ._.: ; _ . 1 f;s~or 23p , 60 tiz.155p a ~o• ~ ~,:~.. RPAA, tttdltirt overload ~ --~~ ~ S~4~ Q.5 HP:. dH~ e f r H....~..~ .....~.....; ~Y . ~.. _.. ~ _. 15 V, St11ir.155Q i~PM, ~ a . _ _ .. }~._.. ' .... _ _. ! .. .;_. .. _: a btdit in overload wilt ~ 1 ! ~ . • Power card: 't Q-loot ~ .. ' ~_ . ~ _.. j .. ' ._...: SJT~IW wlit- three Pik ~ } ~ Dt+o!sklin9 At~613 SJ'tW w~ o ~ .......`..~ . , _ < ~ . .. _ .. ,.. tmdin plug ~.. ~s#andand Orl EF'OSj. D '" .~ 0 P 4 8 e~ 10 s2 ~ GAPM~Y ,~ ~_ • Z 7 ~ P i"" Goutds ~ Pumps r2ooo~s ~ ~~T ~TTtndustries >pp,~ t=om zooo :::h^a ~,, ~/ f fop ~ •ci,.. `",~ ~a~~ 1 ~'~- ~.. Sgt ~•D ~~ ~~~ F ~ti p u~C. 3 ~~ ~~ ,. ~1 ~~ Un. ~ A ~~ :~ ~ o~ ~ ti,-3 ~~~ ~`~~~~ ~ r ~. N ' ~. ~ r-1 t~ o ~ ~~Y; ~ar~se. ...• .~ n .~ ~~ s ~e,` ..,6 .~,~ ~~ ~~ ~G f ~ndv +~-~r~ /~ , '~ .. '~ ~ ~ ~jr ~ ~~h~~ 1f ~ 1~ t oJ? ~, v v ..°" ~ ~ ~J~, NVJ ~ SEC,12,T29N~RI~aI/ . ~'~ ~ ~ a F ~ ~~ • lG ~'G~~,rn ~ ~fr~n e~~an ._ .-,:. 1„, ~~ . 0 ~~~ f ~~~ a. ~~,~ ~ ~ i ~wo ~ d ~; f e ~~ ~- -~ ''~ ~ ', 1441 - _ `~ WieoareinDapartmentviconrnave SOIL EVALUA1'KJN REPORT p~ ~.!-_.a 3 _. . DiNeion of safety and Buil~ngs to aooardanoe wNh Comm ~, vvr. Nin. Cads AC.E. Sail 8 SNa EvaluMlorn 41bq+ aoaiplele>1N plan ap pepec aot leer flan tiff z 11 iieba~ b etoe. t~tea ar~et ~`~ _ 3t. Croix bdede, but aot tia~edtoc wdlalaed badmiWinlearaoeaoNt aarelsa~ .____ _ _....__ __ ., pbrosnt slope; wade a dr~eferie, north amew~ and bceroe /epnoe b awMM rasd. t~sr+eel t.D. 004-1027-50.000, iDaY1228.15.183 P/rss* prh-tali dr~r~tattlon. - --__ __. _._ ___._ _ __ _. _ _ _ ._ . __ _ _ .... _ Revieswd By Dab w~aw hannaa~ yarproYe. wqM wee 6neoaeeq p~owe ~:, tea (11 N~1. , Property Owrar ProPartY tccafon _OanBMar~-,loR~ _~~.___ ~ .._._._._ cla~.~ot .~..-,..._~NE 1!4 NW 114 _S _ ~?. _T-....29.-..~?R_ _16.w.. Prapeity is 1Yhblrlp /lddreee LAL ~ ~ Block et TSubd. IVams a C8A~th ~ ~ 483 320th Street _ ~ . •- City Stab Zip CocM J ~ J ~ lG Town Naerwt Road ~ P i Wi 54749 71 Cad 50Th Avenue d New Caratrtxdlon tNax d Reeiderrlipt! Number ai badroarra 3 Code deri+Ad design ttow Bale _;._ ~..:45Q GPD _~ Replacement ~ J Put4ic a eaanrrrei~cfal - Deacrbec . _.. _ ._. _ Parerk rraleriel _ Q TiN ~ . ,_ _._..._ _- _ _ __ __._ . ..._ Flood pWn dekMion, x applicebts _._. _ _ na_ __..._.._ _ _ . _ _ ~tinerar camrena and recamarrdetlorra: Mound syslwn elw, • 100.84' et 24" above 98.64' owlbur. _ _. _ .. __ _ _ _ ... n Baring ae ~ Borirp rr ~E i " __ .. Pd ~ C~r+ound 8errfaae Mwc .'.~.7Q._- R. Daplh On In#g hclar .~ 1'~ -_b. Sop Ap~G an Reb Hereon Oeplq Ooabwat Color Redax Ogodpiton Teelas CpaiMea fteundery Roan ._~__ ~_ _~ 1~'~ ~ _ none _.._ Sf - -- 2thbk - ~ • da 4 cs 2f,1m ~ 0.5 ~ - ---1- ' -- 0.8 -- 2 4-14 ! 10yr4l3 none ~ 21~k ~ 0.5 r mvlr ! 1f~vf 0.8 3 1 14-18 i 10pr4/3 fZf 7.5yr'S!8 , t si (~ 2lfsbit mvfr ! ^aw i 1fm j 0.5 _~ _ _ ~ . .. ~ ~ -, 0.8 4 16-25 ~ 10yr518 f2f 7.Syt5/8 I fsl ~ 2msbk rim doh ~ gw 0.5 r 0.9 r .. _._ 5 25.44 1 ~ 0~ _ ._ ~f7.6yrs/8 _.._._ ~ gr.fal ._.__._ _-- - imabk -----i ---- -._ _..._ - - j ~--- .. . dsh ~ 0.45 . . _ 0.8 _ _. __..._ _____._ _._._._ ~ _ _ ~`" ~~ _. ___ ._. _ y -! ~.- .. ___._. _.._._._j__..___ _ __.' - . _ . oB~g~ rj Pit Cko«aid Surtaoe tlev. 88.28 __, h Dept b>Mr~ ticbt 1 ~" in. Sai Ada Rob Harms ~ t~asaaCoior Redor; Dwaiption , -Testbe+s CerMelenc: , ttorp-dery ; Rnnt~r _ GPOIRs ~ _ ._ _. ~ . ~ 'Et'~'i ~'Et1At2 1 ~ 0-3 10yr3/2 none _ _. ____,~.~.._..,._ ---.-,._.._ _.~ -~- 4ii . 2febit ~ ds ~ ca ~ 2f,1m ~ 0.5 ~ 0.8 2 3-5 10yr4/Z none ~ _______.....w_____---_.__. _ . _ .-._ ~ >li }...__.__ ___.,_,_ 21abk ____..._...____ ____.___ mvtr~ ~ _____. ,. _.---...-i--..-----~----- ._ .._. ~ cw 1>~6vf 0.5 0.8 ~___ ... -- 3 5-12 ! i0yr5/3 none ___._ _.____ ._____._.________._._.._.___ __.. . adl ~ 2fabk. ~ mvfr aw + 1fm ~ 0.5 0 8 { ._. . .___ ..._~_ .~ ._ . _ _ _-- - - -_. _ ..__ .___. 4 ' 12-1t3 i 10yr516 m2d T,5yr8J$ ~ _ ... _ _,.~._. _.__ _... _ _..r..__ fBi i 2mabk dsh ~ _ __ __ -. ! 1fm ~ 0.5 f 0.8 ~` ~ , . ~_. ._ 5 18-38 ` 10yr5/8 fZf7.5pr516 ~ fa! ~ 1mabk ( dsh ~ - i 0.45 0.8 . _.. 1 _ ~ • Ettluent a1 ffi BOD ~ 30 < 220 mg4. and 7t3t3 ~~ 130 myL Jsmes K. Thomp~n $ AC.E. Said. Site E+rakraNons BODs ,30 ngR. and 785 x„;10 rrigA. CST Number , _ 3602 Dale ~ Condtrcled Telephone Number 7nam1 715 2aa-77t37 ee'" ~ '. -Pir~peity Owner . D!ar+ & Maiy b Rhy ___^____.,...,_.. paraN D / Oa4-10X1-50.000. IOi12.28.15.183 ~ _.3- _ ~ _~.. a ~~~ 'J ~ 96. R. ~b~ iaclor 15'_, in. d.~ ~~ 5S :>dAppYalioa~a OambadCola , ~. ~ : .~ 1 0.3 10yr4R norw sl -.' 2fsblt ds cs 2f,tm 0:5 . ~ .. 0.9 - 2 ` i 3-i 1 ~__; ~..~_ _--- t rare s>f mvtr 1 cw i ~vf ~0.8 0.5 __ __ __.__._._..a .__.._._ _ -- - ---____;________~. __.___.. 3 ~ i1-15 ' 10yr5r4 none q 2fsblc mv0 t sw itm ~-8- 0.5 _ _ - A 15-19 t i0yr5t4 5yr5/8 }NT ~ ~ ...~._ '~_ . ____ __, ___ ._., . _ ,_ 5 ~i9.36 ! _ T.5yr4W QfT.6yr5/8 gr.isF: _ tmabk !~_~ i _ ._.._.___. - .__. a.a5 ~ 0.8 _...._. _ .. ..__.._--_ __ _ _._ _ _ _ ...-.r_.___ J ~ ~ * _,.~- it., .. .Qeiau-lot1~_ _~, __ :, _ ~... ~ - _- ..-_._ _ ~ Pk _ _ G„oaM ~sts~oe Nr„ _ sce ~p~Oeaon Rya Fiodaan ~ DepN Oaixignt Color 1lelbr Terra SfrYOiere 8aende7 ~ 1 ~ -- ~- - r~~-t_-___...~_.. .~ ~ _...__ ~ _~... ... _. _- _.- _,.-. ._._ . ._..~ ~ ._ ._ r_. .~.._~._.._._.~.....___.~. ~ .. 1 ~ t ~,~ J ~ J PR Gtoftetd Surfaoa elwr~ ~ . ~ tiD hdor _._._ _... ~• Sai ~ Rde Horirar i Deytli OomNmt Cola Redoic Oaw~(plfan Tledaie Canoe , Roos '@MZ~ ~ ~ r ' --...___ ._ _j----_ _---}~---_ r_...-.... _ _..... .rte _...._. --~---~-~ _ __..j_._.~~... ,_._._ ~___ _._.- ___ _._. i i 1 - ..... -.. S # i i t • EIltusnt r~i ~ BGq ~- 9D <220 a+p11, and'i's~ ~1 s~l10 mprL • art d1Z • 800a <~0 rrplf. acrd T88 <~' R melt. '!rie D ofC b aaerprdoppartoaityaierviae pno~vidcrandanpMdya: Uyar Hood aae~anae w aaxss acrvioesa seed erawaial in an aNenoMe olee~e aonmd Ara depMareat et60~266~31St a1TY b08-Z64-t?97. ~i ...,.~"# ~',. s /~. cam: iz9 "' LSD 8.~ ~Jvi~ @l/a/K,~'~+Cn ~~ ~ ;~ ,:~. p~ ~ Sc~a ~ar, fi ~'y ~'o sky /lEhc~J, Sec` /2,'Tn• o ,~,." C,a,dY 5t.. Cra; ~c Co•, ~' +~ I 1/ -~' p cFYi` . r t„tx.~. E't~cr= = jai ~• ~0'(y„~bors~" ~~ ~g o 9xo" 9G~0~ ~j~~~ ~ _ ,.~ -_ C5 / .~y s SOIL EVALUATION REPORT ` Wisconsin Department of Commerce Division of Safety and Buildings ;,, y,,,,,,,~~ ,.,~, r.,..~„ :3s tinru nom, ~~, 1441 Page 1 0# 3 aC.E. Sal 8, sites EvaA~ations Attach complete site plan on pier not less than 83~ x 11 inches in size. Plan must ~~ St. Crobr include, but not limited to: vertical and horizontal reference point (BM), drcecctieor- and Parcel I D percent slope> sc~e or dimensions, noM arrow, ~d location and distance to nearest road. . . D# 12.28.15.183 I 004-1027-50 -00 0 , Please print all lnformatfon. ~, Date ~ ~ Personal v~forrnation you provide maybe used for secorMwy W~P~ (PriwacY Law, s. 15.04 (1) (m)). `~~/-'o-'v~-- ~ ~ , JI ~•G~ Property Owner Property Location Dan, & Ma Jo Rhy Govt Lot NE 1/4 NW 1!4 S 12 T 29 N R 16 W Property Owners Mailing Address t.ot # Block # Subd. Name or CSM# 483 320th Street City State Zp Code Phone Number YJ City _ j Ydlage ~ Town Nearest Road Knapp ~ WI 54749 715-684-3033 ,~~ Cady 1~F14 nue ~'~ .,. ~...~~ ~ New Construction Use: a/ Resk~ntial / Number of bedrooms 3 Code derived design flaw ~,f'~ X60 ~ GPD~ _~ Replacement .J Public or conar>er~ -Describe: `ter -~~ Parent material Glacial Till _ Flood plain --~ icablen General CORNrIentS ~ ro : ~P t ~ ~~ and recanmendations: Mound system elev. = 100.64' at 24" above 98.64' contour. ,- ~; ~`" 1_ 1 a Boris # --=~ Boring ~ Pit Ground Surface elev. 98.70 ft. pepth to limiting factor ,~ ,, r w , ~ 4~~ in , ^ . So~'A~p on.Rate HorizCn Depth Domin~t Color Redox Description Texture Structure Consistarce dory Roofs GP DIft' "E 1 0-4 10yr4/2 none sl 2fsbk ds cs 2f,1m 0.5 0.9 2 4-14 10yr4/3 none sil 2fsbk mvfr cw 1 f8~vf 0.5 0.8 3 4-16 10yr4/3 f2f 7.5yr5/8 sil 2fsbk mvfr aw 1 fm 0.5 0.8 4 16-25 10yr5/6 f2f 7.5yr5/8 fsl 2msbk dsh gw 1 fm 0.5 0.9 5 25-44 10yr518 f2f 7.5yr5/8 gr. fsl i msbk dsh - - 0.45 0.6 Boring # _I Boring N Pit Ground Surface elev. 98.26 ft. pepth ro limiting facto- ~ m. Sot Application Rye Horaar Depth Dominant Color Redox Description Texture Stnrcture Consist~ce Boundary Roots 6P D!!t= 'Eff#1 ' ff#2 1 0-3 90yr3/2 none st 2fsbk ds cs 2f,1m 0.5 0.8 2 3-5 10yr4/2 none sil 2fsbk mvfr cw 1f&vf 0.5 0.8 3 5-12 10yr5/3 none sit 2fsbk mvfr aw 1fm 0.5 0.8 4 ' 12-16 10yr5/6 m2d 7.5yr5/8 fsl 2msbk dsh gw 1 fm 0.5 0.9 5 16-38 1 Oyr5/8 f2f 7.5yr5/8 fsl 1 msbk dsh - - 0.45 0.6 '" Effluent #1 = BOD 5> 30 < 22p ~L and TSS >3(~< 150 mglL ~ ' Ef~la~it #2~ODs<30 mg/I- arxi TSS <~30 mglt. ,~ ~~ .~ . (~ James K. Thompson ~ ~ '~ 3602 Address aC.E. Soi18~ Site Evaluations Date Ev~uation Conducted Telephor-e Number 340 Paulson Lake Lane. Osceda. WI 7/24/01 715-248-7767 ~ ~ .' Property Owner Dan & Mary Jo Rhy p~ tp ~ Q04-1027-50-000, ID# 12.28.15.183 Page 2 of 3 }~/ Pk Ground Surface elev. 96.55 ft. Depth to limiting factor 15" Soil Application Rate ~~ # ~ ~~ Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots "Etf#1 *Eff#2 1 0-3 10yr4/2 none sl 2fsbk ds cs 2f,1m 0.5 0.9 2 3-11 10yr4/3 none sit 2fsbk mvfr cw 1f8vf 0.5 0.8 3 11-15 10yr5/4 none sit 2fsbk mvfr aw 1im 0.5 0.8 4 15-19 10yr5l4 f2f 7.5yr5/ fsl 2msbk dsh gw 1 fm 0.5 0.9 5 19-36 7.5yr4/4 f2f 7.5yr5l8 gr. fsl 1 msbk dsh - - 0.45 0.6 ^j Pit Ground Surface slay ft. Depth to lirnking facxor in. ~ ~ Rate Haizai De th Dominant Cola Redox Descri tion Texture Stnrc~ure Consistence Boundary Roots p p *Etf#1 *Efft1C1 ^ Boring # ~ Boring _~ Pit Ground Surface elev. ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Cola Redox Description Texture Stnkture Consistence Boundary Roots *Etf#1 "Eff#2 . ~p .~ ' S- Effluerd #1= BOD ~ 30 < 220 mglL and TSS >30 < 150 mgJL * Effluent ~t2 =BODE <30 mglt. and TSS <,~0 rrgll Tire ~-t of Ccrrnmerce is an equal opportunity servke provider and empbyer. If you need assistance to access services or need rrra6eriai in an attern~e forttrat. vlease contact. the de frrient ~ 608-2Csfs-3151. or TTY 608-2~G4g7T7. • .. .. __.....--~---- `~ ,~, ~~ ~.-.---- ~ Soil $~tt6r,~r~"~ ~'~dQ-~,°r' !O O s /do. Q`J: ix9 •~. ~..~Tb'p oFYi~ , rc,t~~. ~~~= = is ~• : l '= 5~4~ j~an~' ~-/.TC~~Y~ ~~, 5t C.ro;,c Co., • ,6,rv. 99a ~~ .-, 1~ ~ '9r0 , qd.4' v ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer t~~ ~ f= n'1 ~ /'1- h Cr u di f!/~ a ~! Mailing Address <~~ U ~ ~ a ~ ~ ~ (- ~~ ~' d ~ , ` ~ (C ~ ~^ ~ ~ U'L. Property Address) a~ ~~ (Verification required from Planning Department for new construction) City/State ~~~ ~v ~ ~ ~ e ~ ~ Pazcel Identification Number 06 ` ~ ~' 2- 7 ` S--v ^/ ~ u • 183 ~ -~°~ LEGAL DESCRIPTION Property Location ~ '/., ~~ ~ '/., Sec. ~ 2- . T 2 ~( N-R ~ ~ W, Town of ~ ~ ~ N Subdivision .Lot # ~ r Certi£ed Survey Map # ~C C 3 S~L .Volume ~ S~ ,Page # C-l Z 2 ~ Warranty Deed # q S (3 3 ~ .Volume 2 Y ~ ° .Page # 1 ~ y Spec house ^ yes ®' no Lot lines identifiable ^ yes ^ no SYSTEM MAINTENANCE 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. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeymanplumber, restricted plumber or a licensedpumper verifying that (1) the on site wastewaterdisposal system is in proper operating condition and/or (2) aRer inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standazds set forth, herein, as set by the Department of Commerce 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 Zoning Office within 30 days of the y ar expiration date. / / SIGNA OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property descri ove, by virtue of a warranty deed recorded in Register of Deeds Office. / / SIGNATURE OF APPLICANT DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made is the warranty deed v. ~K9o P. ~S4 nocuMe~T No. STATE B71R OF WISCONSIN soars i wAxRnx~TZ Haan This Deed made between Danny E. Rhy and Mary Jo Rhy, husband and wife, Grantors, and Jeremiah J. Gunderson, single person, Grantee 7 5 1 3 3 7 KATHLEEN H. WALSH REGISTER OF DEEDS 5T. CROIX CO. , NI RECEIVED FOR RECORD 01/12/2004 10:LSAK MARRANTY DEED E%EMP7 # REC FEE: 11.00 TRANS FEE: 82.50 COPY FEE CC FEE: PAGES: 1 Witnesseth, That said Grantors, for a ~T~R T~ ~16aV~t~ valuable consideration conveys to Grantee the ~ BOX ~ following described real estate in St. Croix Ha1f1fl10fl0.W1 54015-0028 County, State of Wisconsin: ~ /~.~03 /~~ Lo One (1) of Certified Survey Map recorded December 26, 2001, in Vol. 15 of pg. 4226, as Doc. No. 6 6356 being part of the Northeast Quarter of the Northwest Quar er (NE 1/4 / NW 1/4) and the Northwest Quarter of the Northwest Quarter (NW 1/4 of NW 1/4) of Section Twelve (12), Township Twenty Eight (28) North, Range Fifteen (15} West, Town of Cady, St. Croix County, Wisconsin. parcel ID#: 004-1027-50-100 This is not homestead property. Together with all and singular the hereditaments and appurtenances thereunto belonging; And Grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and roadways of record, and will warrant and defend the same. Dated this ( ~~ day of -$u ,-. ~-c~-.,,~ o~C~c. `,",~~~rAtluni~,~,' ~.. Kq ~ (SEAL) AUTHENTICATION (SEAL) Signature(s) of authenticated this day of 20 . TITLE: MEMBER OF STATE BAR OF WISCONSIN (If not, authorized by 3'706.06, Wis Stets.) ,. ~. ~ C.)P.'OS SEhf~)' army E . R y o-v STATE OF NIISCONSIN)ss. Personally came before me this ~ day of\~~~ 1 d' Q 0 the above named Danny Rhy 5 Mars Jo Rhy, to me known to be the person(s) who executed the foregoing instrument d acXnowledge the same. Notary Public County, Wisconsin My commission is rmanent. (Zf not, state expiration date: ~ f 6~~Q+~/ THIS INSTRUMENT DRAFTED BY G.F. Gunderson P.O. Box 159 Spring Valley, WI. 54767 ,,,,^`~. sss~ess y...r IC:N Il_._ 15 w=• If~~I ~a E_' 4226 KATHCEEH~ H. WALSH -- ......." REGISTER OF DEEDS ST. CROIX CEI. WI kECEIVED FOR RECdRD 12-26-2001 11:5 NM COpY FEE• 3.00 __ RECDRDING FEE: 13.00 CERTIFIED SURVEY MAP ~r~~~~~ ` t OCATED ! N THE NW 1 /4 OF THE NW ! /4 AND ! N THE NE ! /4 OF THE NW ! /4 OF SECTION r 2, T. 28N. , R. 15W. , TOWN OF CADY, ST. CRO 1 X COUNTY, W I SCONS I N oro O ao S O" y O 8 ~ ~ x v m v m t ~ U ~ o T I I LOT I I .. .. ,CERTIFIED SURVEY MAP .................................... 1 1 VOL UME ! 5, PAGE 4 1 / 6 '----- - _ _ NW-NW _ _ NE-NW 2 : nl : ~ ~ ~ • O •17'1 1 M N . ~ Q pp >`+ ~ o w~ C z ~ : y c~ nX ` ~ ~ m .Np, o z ~ =c~ z ~ r~ Z ~ ,o z~ D y m r ~ b z m O g g Q : 't r+7 Z z a rZi n .- oz~ ~~ \ ;....~ r rm~ ~ ~° ~ ~~ 4: a7O ~'. w j ~~''~ii...'rtltnrtlgtttU~~ `z c7 H N oa• os' sa• w Qrs. T~s' ~p ` - ~n 2 T t~~ I Np-p{Z 12 ~2~ ~ rn A ~ ~. N (") ~ I ~! 1 O 'clg ~'~72 I ,,, m ~ ~ 1 v Z I ~ Ix o I T ;= I ~ -~ 33' I rZ+l I ~ I \ I ~' ! 8D. T4' 33. t~0' I I r oo' I I I 33' I I I ~I = x ~I ~ : :~ o~ I ~: _ osow ~I Q Nnogov Q ml m; a' p~o~ ,+-o T '~1 i D ~ I r : ( iI -'~ 7p : I - I ~ ~' I I I I :S r oo' I I :Z ~ I I ~ ' I s ~~ res. or' 28. T3' ~ S 00.03' 3'.i' E Q J 3. 7~`® I Z I 'C m I _~ ~ I .1- I °f ' --I $ I '~ .1t1 ^I I ~, : ~ =' I : ~. I .p o t ~y 6' ~ I' ~ .,UNPLATTED LANDS ~ f .............................. m y , ~I ~ ~ ~m m A q \ O~ NORTH QUARTER CORNER ~t$.\ \ SECTION r2 FOUND \ 3/4" IRON REBAR I ~ ~\ t ~ '~ ~o n'1 a m a° z ~' i~ UDC 2 6 2001 If not recc,:., ~ .:,., ... ~ ~r=~ s or approval date app*^v~~ S;;all be n :..~h •.a^: ~! C~n~7A ~C OUi o~o 2 -zr~ n~ U ~ H c~c romp pm• o~ ~~ ntn~ynt ~' ~ b Rtin ~~o~a 3X~~0 ='~ o m Vol . 7 5 Page 4226