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HomeMy WebLinkAbout004-1055-60-100Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may Ne used for secondary purposes [Privacy Law, s.15.44 Permit Holder's Name: City ^ Village ~ Town o~ CST BM Elev.: 1n5p. tlM tleV.: nm ves~npuvn. TANK INFORMATION ~" TYPE MANUFACTURER CAPACITY Septic Dosing n ~ (~ _' Holding ~u ~~~ 'CJ1br TANK SETBACK INFORMATION TANK TO P / L WELL BLDG. vent to Airlntake ROAD Septic ~ ~- per.} ~~ ----_.__, ~ Dosing ~~pfi .~ ~~i"" ~~} NA Aeration NA Holding PUMP! SIPHON INFORMATION ~ ~y.;,,,~~ Manufacturer ~ Demand Mode! Number 3D•~GPM TDH Lift~a• I~ Friction ,~ ~3 System T 3S ~ Forcemain Length yfpUl Dia. a ~I Dist. To Well ~ ~O~' GAII AR«1QDTIAIU CVCT1g11A c1 t:veTlflN DATA County: •. ~~~~ Sanitary Permit No.: ~~; ~ 1 State Plan ID No.: ~~ Parcel Tax.No.: L~ ~ y. d~ ~• 1S". 3 f ~ a- STATION BS HI FS ELEV. Benchmark , j ~ 1 p~~'3 + ~ Bldg. Sewer St/ Ht Inlet St/ Ht Outfet Dt Inlet Dt Bottom Header /Man. . ~}~ 3~• 3 Final Grade y~~" ~ `f ~ ~~~ ~ b v~ S / i id h BED /TRENCH width Length No. Of Trenches PIT No. Of Pits qu Dept Inside Dia. L IM I N SYSTEM TO P / L BLDG WELL I N LAKE / STREA LEACHING Manu adurer: SETBACK INFORMATION Type O ~ `~ ~ f I~~ `~~~~- CHAMBER. OR UNIT Mo a Number: System: ,1~1~r (~ - p~ 1'11CT~ID1 IT1AA1 GV~TCIIA /'.~-,\ ! ,,..I .,....~ I ~~--7 ~..~Ge o't' ~/ to ~+.+«^ ~.~..~.~~..~.~~~. ~ Header/ Mani old tr h ~~' ~ Oi ~ .^ IV I,JLx.:i . Dist b ion Pipes ~ k ~ Spacing ~ th Dia l x Hole Size ~ 8 x Ho a Spar ing Vent To Air Intake 3.3 ~ Lengt a. . eng ~ n SDIL OVER x Pressure Systems Only xx Mound Or At-Grade Systems~-~M'~~,~~y,, Depth Over Depth Over xx Oepth Of xx Seeded /Sodded x Muk ed Bed /Trench Center Bed /Trench Edges Topsoil ^ Yes ^ No Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) ~' (p ' ~ _ `t t ' 5 e S~~ ~ w iuc~ Plan revision required? ^ Yes ,~No '~ ~,.- ~~ Use other side for additional information. canx~in ra vro~~ Date Inspettor's5ignatur Cert. No. _ ~ ~~,.}_ ~, sg ~ a cif ~~r ~n~ ~~F , s~ ~- _ ~ y..3 << o~ -- ~~ ~~ = ~-~. ~-~ ~ us ~ n ~ • o C~n`~ 1 ~a ~~ ~' ~ 5 ~~.,,kF~~ r~~ ~-~--ate v~aS ~ 3• ~ ~- Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division ~. , 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 Sorenson, Nate Cad ,Town of CST BM Elev Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER ~...~,~ ,~; ~ CAPACITY r Septic i ,~v .. .w ~i ~~._ y .. j V 1 Dosing ~ d~• .,! Aeration ~, .__~ ~ ~ ~~, ~~.. Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length , Dia. „ Dist. to well t~;.;. ~:,. C(l1I ARSf1RPTICIN SYSTEM ELEVATION DATA County: St. CrOiX Sanitary Permit No: 506221 0 State Plan ID No: Parcel Tax No: 004-1055-60-100 Section/Town/Range/Map No: 24.28.15.376A STATION BS HI FS ELEV. Benchmark C~_' j t. ,.,, eE a~~ Alt. BM Bldg. Sewer •~ y SUHt Inlet _ 2-1 ~ ~Zi St/Ht Outlet ~°°~ -.i f Dt Inlet ,~° ~' Dt Bottom • z.+ -7 e~ ! , Header/Man. Dist. Pipe Bot. System Final Grade St Cover I ` ^~ 7 r- BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: CHAMBER OR INFORMATION Type Of System: UNIT Model Number: nICTDIR11TInA1 CVCTFM Header/Manifold Distribution x Hole Size x Hole Spacing Vent Air Intake Pipe(s) ~ Length Dia Length Dia Spacing Cf111 CnVFR .. o...._......,, e.,~a.....~ n..i.. ..., nn.,~~.,.~ nr Af_(:rarla Svstams Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ~ Yes °:' No ~;. ~ Yes = No ~~ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:_~_/ ~ ` / ~.r` i~µ) Inspection #2:__/ / Location: 3211 30th Avenue Knapp, WI 54749 (NW 1/4 NW 1/4 24 T428N R15W) NA Lot 1 / ~('~~~ y f'`~ ;; ~,; ?,arcel No: 24.28.15.376A V, 7ri', ~;r;x'~ 1'• 1.) Alt BM Description = o `; ,w,~.~°~ ! 2.) Bldg sewer length = ~>,"y~~ ~ , ~ ~ j,~- - amount of cover = ~ ~+ .•r~ , .-~ , t i Plan revision Required? ', Yes ', No Use other side for additional information. Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) '` Gg111f!'i@t'C@.W~.~jOV Safety and Buildings Division ~ 201 W. Washington Ave., P.O. Box 7162 ~~~(~'~~ Madison, WI 53707-7162 17epa~rtmerrt of Catrurterra Sanitary Permit Applicat~ In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form unit is required prior to obtaining a sanitary permit. Note: Application form submitted to the Department of Commerce. Personal infoanation you provide purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. I. A lication Informatio ease Print All Information Property Owner's Name / NATE SORENSON N403 FOOTE AVENUE SPRING VALLEY WI 54767n (~~1 II. Type of Building (check all that apply) 3 B~b~[Ccb ^/ 1 or 2 Family Dwelling -Number of Bedrooms 1 f~ GA S~ot~ ck# ^ Public/Commereial -Describe Use N/A ~..o~Se._ ~1,~, ^ State Owned -Describe Use ~ ~ n CSM Number ID ~ ~J /~D~ 11 /_ ~ I 829687 IIL Type of Permit: (Check only one box on/line A. oooCCCCom`-pClete line B if applicable) A' /^ New System ^ Replacement ^ Treatment/Holding Tank Replacement Only System .reel # /DO 14-1055-60~- operty Location Pvt. Lot N '/., NW T 2g N; R 15 Subdivision Name N/A 38 37~ ~ '/a, Section 24 (Check One) ^ E ^/ W U City of ^ Village of /^ Town of CADY Other Modification to Existing System (explain) B. ^ Permit ^ Permit Revision ^ Change of ^ Permit Transfer to List Previous Permit Number and Date Issued Renewal Before Plumber New Owner Ex iration IV. T e of POWTS S stem/Com onent/Device: Check all that a 1 6 0 ~J ^ Non-Pressurized In-Ground ^ Pressurized In-Ground ^ At-Grade ^ Mound >_ 24 in. of suitable soil ^/ Mound < 24 in. of suitable soil ^ Holding Tank ^ OTher Dispersal Component (explain) ^Pretreatment Device (explain) ~ r V. Dis ersal/'I'reatmentArea Information: a.~.. Design Flew (gpd) Design Soil App ' on Rate(gpdaf) Dispersal Area Re Cued (sf) Dispersal Area P osed (sf) System Elevation 450 ,/ 1 ~ 450 ~j ~ 450 ~ ~ 97.75 VI. Tank Info Capacity in Total # of Manufacturer Material Gallons Gallons Units New Tanks Existing Tanks Septic or Holding Tank 1000 1000 1 WIESER CONCRETE Prefab Concrete Dosing Chamber 600 600 1 WIESER CONCRETE Prefab Concrete VII. Responsibility Statement- I, the undersigned, assume responsibility for installat' n of the POWTS shown on the attached plans. Plumber's Name (Printl Plumber's afore MP/MPRS Number Business Phone Number BENNIE HELGESON 220292 7151772-3278 Plumber's Address (Street, City, State, Zip Code) W1229 770TH AVENUE, SPRING VALLEY WI 54767 VIILCounty/Department Use Only YApproved rY Permit Fee Date ssue Issuing ent Signature `~, iven ~ n~Q for Denial $ / Q ~ pp /_ ~ Q IX. Condit~~ `~ easons\for-'Disapproval~0 1G~ 1. Septic tank, effluent fitter and dispersal cell must alt be services / malntalned as per management plan provided by plumber. 2. AU setback faquirerrtents mt~t be maiMainmd Attach to complete plans for the system and submit to the County only on paper not less than 8 12 x 11 inches in size rw t ~ are secondary County ST. CROIX Sanitary Permit Number (to be filled in by Co.) 5b (o Z Z I State Transaction Number 1396032 ~ 3z~~ JUN 0 5 2001 one $gfjtl~OlX COUNTY 15/780-2349 SBD-6398 (R. 01/07) Valid thru 01/09 ~~~re 2LSc c-~ ~Dr, ~e t~~ _ - ~ ----_. . ~, ~i i U .:~ ~tlt~tb«1 r a _. N~~ o"r iv tLi '~ S e L, d y 7~~ ~ 1J ~ f 5 w C. ci~7 ~©wu 5 I1, 4,~ S7". C2o r~ Co~.~rL7 /~.G:3 a.c~e ~«r:pl C~ ~-Q ~~t~~~ i (`Xc ~ ~'f ~~ts ash a~~~~ 1 ~ ~ 3a~d S~op~ i -,~`I Y~ ~r~ i v ~~. , L ~/ ~\ i ~~ ,~~ a ~~ i U , i I~ I~ i ~ ~-- ~ I ~ T~•~~a C~(~ ~~ - s. <~c,-Lf~. ~~2- ___ _. ~ I c~bo i ,,,. iSy bl ~ I I t ~~O `~ ~~ I C'~ ~L -. abo ~P~~ ~~ C~-14~ . ~ ~'e - 8 -~ :~ ., ~ ,. ;~ 1 e2~1 a,e,r x, '•~ ~~~, <~ 1~ I i I N~ 4 0~ N tc; -~ S e~, d y 7"~ ~ 1J ~ l 5 w ~~,~~ qv, a5 5 7". C 2 o r ~ C ou . ~ f-7 I ~y a' ~ -- ~I ~ n ~f _ ~ ~ ~, I `~ ~kC.p`p S Sio~~ - ~---i ~ j`~ ~ 3 5 ~~ ~/~r ~~~,~ /',~ 3 -~,~; y ~~ tt? roc( commerce.wi.gov isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD to CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary May 31, 2007 CUST ID No. 220292 BENNIE W HELGESON HELGESON EXCAVATING W 1229 770TH AVE SPRING VALLEY WI 54767 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/31/2009 ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 Identification Numbers Transaction ID No. 1396032 SITE: Site ID No. 725458 Nate Sorenson Please refer to bothidentification numbers; 320TH Street & 30TH Avenue above, in all corresondence with the aaenc Town of Cady St Croix County NW1/4, NW1/4; S24, T28N, R15W FOR: Description: Mound /Three Bedroom /Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1131646 Maintenance required; 450 GPD Fiow rate; 18 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual, SBD-.10572-P (R.6/99), Pressure Distribution Component Manual, SBD-10573-P (R.6/99); 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: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. Coed • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption ~~~ area. chs. NR 811 & 812c MEM • 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. SEE CORF • Inspection of the POWTS 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. Stat BENNIE W HELGESON Page 2 5/31/2007 • Comm 83 22(7) A copy of the approved plans specifications and this letter shall be on-site durinE construction and open to inspection by authorized representatives of the Department which may include local inspectors. Owner Responsibilities: Comm 83.52 Responsibilities. 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. • Comm 83.55 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. 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 maybe 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,- ~~~~~ Charles L Bratz POWTS Reviewer II ,Integrated-Services (608)789-7893 , 7:45 am -.4:30 pm Monday -Friday charles.bratz@wisconsin. gov Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544 ,Friday, 7:00 A.M. To 3:30 P.M. PROPERTY OWNER: INDEX SHEET NATE SORENSON N403 FOOTE AVENUE SPRING VALLEY, WI 54767 PROJECT NAME: NATE SORENSON PROJECT LOCATION: NW 1/4, NW 1/4, S 24, T 28 N, 15 W MiJNICIPALITY: TOWNSHIl' OF CADY COUNTY: ST CROIX REGEIVEp h~AY1t2001 SAFE~`Y ~ ~~UI~.~~rjVGS DESIGN: PRESSURE DISTRIBUTION MANUAL SBD-10573-P(R/99) MOUND COMPONENT MANUAL SBD-10572-P (R 6/99) CONTENTS: Page 1: Plot Plan Page 2: Cross Section and Plan View of Mound Page 3: Distribution Pipe Layout Page 4: Septic Tank & Pump Chamber Cross Section and Specifications Page 5: WLP 1000/600-MR ZABLE Tank Specifications Page 6: Pump Specifications Page 7: POWTS Owner's Manual & Management Plan - Pg. 1 Page 8: POWTS Owner's Manual & Management Plan - Pg. 2 Name: Bennie Helgeson Address: W 1229 770th Avenue Spring Valley, WI 54767 Credential Number: 220292 Signed Date: May 9, 2007 ~'o~A~ry Q~~ OF .ESPONDE E ~wh~tl ' ~l ClT P ~G ~ c-~ Y"L - Synthetic ~-overing . ~ S T/~"t ~.. 3 Medium Sand -~ \ ~ Topsoil '7 ~--_ J I 5 ,tlg~ ~ of Distribution Pipe -=,\~TG ' L u ., Con Plowed Lcyer y % Slope i" Aggregate _ Cross Secii ~n Of A Mound Force Main From Pump ~, jO Ft. - Q _~ Ft. Signed: ~ ~~Ft. License Number: --- ~ ~ (o Ft. Date: -- d ~ Ft. I ~ Ft. ~~ ~,s Ft. L B p ~~- r t . E /. ~ F t . F 5~~~ F t ~ Ft. H %. C- F t . _ Observotion Pipe ~K ---- _____________________t ___e ~ . ~l _____._.___"_- T~ ~`~~ of 2~_ 2 L ~Distribufion re ate Pipe A99 9 Observation Pipe ~a.Sal ~r~o.. Plan View Of Mound (at~rter; ~a~ ~jore.xtSOn Perforated Pipe Detail Cleanout Access ~ Threaded Cleanout .~ ~'%~~ ;~~ End Vle.+ lNo,~oro~~~ , ~~ /End Manifold •~ Holes Located on Bottom \ Are Equally Spaced Force Main From Pump First Hole Next to Ma~tifold Signed: License Number: Date: P ~~~ ; ~i R ~y S ~~'~ ~ ~, l' ~.r. 1 _n Y J ~; Hole Diameter l~ Inclt Lateral " ~`~~ Inch (es) Manifold " ~ Inches Force Main ` ~ Inches Invert Elevation 9~• ~ S Holes Per Lateral ~~~ 7 Number of Laterals . -~ Total Holes ~ ~~ Cleanouts Distribution Pipe Lavout t~wrle,r : (Vn ~~r n o n Page~Of ~ SEPTIC TANK E PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS ~~ 4 •~VC_VENT PIPE 12" MIN. ABOVE GRADE E 25' FROM DOOR, WINDOW OR FRESH AIR INTAKE ~~ ~ ~7 WEATHERPROOF JUNCTION BOX WITH CONDUIT APPROVED MANHOLE COVER W/ PADLOCK E WARNING LABEL 18" MI I N LET ~ ~ ~ ., ~ ~ WATER TIGHT SEALS T F~ttER - A Qv~ ~~k ~- APPROYEO ~~S B PIPE 3' -'~ ONTO SOlIO C SOIL PUMP OFF ELEV . g~~~FT. -~-- D ~y" ~. A. ~~ ~ ~~ I ', GAS- ~ ~, TIGHT• SEAL ALM ' ON ~ ' OFF 4" MIN. • ~~ I8 M1N. APPROYEO JOINTS KITH APPROVED PIPE 3' ONTO SOLID SOIL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS ~ ~ I ~ ~sl s ~ - l ~-•rirs.~s' -_~nir T" SEPTIC / DOSE ~, S X S ~ ~ G~{I . TANK MANUFACTURER: Lv~PSec-- - --- TANK SIZES: SEPTIC ~~ GAL. DOSE ~L~ GAL. ALARM MANUFACTURER:< < "< < ~ MODEL NUMBER: _Let H SWITCH TYPE: ~~~_~ PUMP MANUFACTURER: z~~l~~- MODEL NUMBER: _ y SWITCH TYPE: ti1f!•r c-~v~ ~`--~ RE~UIRED DISCHARGE RATE ,3D.7~GPM DOSE VOLUME INCLUDING ~ (C:L,I. 7 FLOWBACCC)~K: //_3.s GAL. CAPACITIES: A = ~b INCHES = ..3~ I.E•$ GAL. g = 2 INCHES = ~.~_ S~? GAL. C = ~ INCHES = ~/~ ,3~GAL. p = ~~ INCHES = ~SC'•$yGAL. PUMP 6 ALARM WIRING AS PER ILHR 16.23 WAC VERTICA L DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE + MINIMUM NETWORK SUPPLY PRESSURFT/100 FT. FRICTION FACTOR . + y~_ FEET FORCEMAIN x •~ ~ TOTAL DYNAMIC HEAD = ~ , 7.5'I' E ET ~...5' FEET -L FEET /.s~FEET WIDTH DIAMETER ________ INTERNAL DIMENSIONS OF PUMP TANK: LIQUID 6E`~N-,~_. LICENSE NUMBER:/ DACE: SIGNED: 1/88 o :: ~ Q ZO'' .~ N ~~~„'. ,_' ~ ~ a~~ O r O ~~ ~ J w .Q ~~ 0 J w w O ~~ o ~~ o Y ~ W ~ ~ a°o ors- vv ~ ~m ~Q z? ~ OJ a ~` JU J-\-~ a cn o O - dV vi Q WHW a s C7~ vi m p ~ ~ p cwi~ ao cn ° ° ~ io via ¢ w cn o0 ~ ° o _O O M~ ~ mN~ NCO r ~ pOrJl~ f-~Q F- a W ~ N~~6 W~s}' M ~.-~ ~ W ~O ZF- ~ j.. Z C~ ODZW e ~W J : ~WH ~ ~ Z W U (n ~ O W O a tii .. o m = _ = p~~~ U~awQ~ Y ~~ O U Q QOO ww ism-~ U~= N3 ~ QU o c~ Z - m W F- J 0 a J Z C3 J J _ W „'LV _~ I +i I' I •1 I I I I ,~ I I . I I I ~~ W. OI LiJ J U (n F „~bB (~ I f E U - i it-- ~ ~ ~ '._ .. rl 1 [~ I ~ C_ ~7 Y ,~ - u°~t`,~: ~o ~~E ~, .. u~ ' o U_ `. ~~ `, r, i > ~ __ '~ ty)I ~/ ~, ~I _~ r.__.__-; ~~' .~- 14 t2 1C Q~ W ~ 6 V Q Z O 4 6 O 0 U.S. LITERS .~ ~ ~ W 4 ~~~ HEAD CAPACITY CURVE MODELS "140/4140° TOTAL DYNAMIC HEAD/CAPACITY pER MINUTE EFFLUENT AND DEWATERING Ft. Melers Gol. Ltrs. 5 1.52 91 3aa 45 10 3.05 ea 318 15 4.57 76 2dd a0 4140 140 20 d.1o ea z57 , 25 7.62 59 223 35 30 9.ia a9 1d5 35 10.67 3B 1aa 3D 40 12.19 21 79 13 72 S 79 25 a5 . LOCk V°I VG: a 6~ 20 t5 t0 5 ALLONS 10 20 30 40 50 60 70 80 90 100 Ito G I 80 you ~~ ~-- 0 FLOW PER MINUTE 010904 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Mechanical alternators, for duplex systems, are available with or without alarms. • Control alarm systems are available for 1 phase pumps used in simplex system. See FM0732. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long cycle controls. • Sealed Qwik-Box available for outdoor installations. See FM1420. • Over 130°F. (54°C.) special quotation required. • Refer to FM0806 for 200° F. applications. 140 Series - 53 lbs. 4140 Series - 73 lbs. 14014140"' MODELS Control Selection _ Model Model Volts-Ph Mode Amps Simplex _ Duplex _ N140 N4140 115 1 Non 15.0 1 or 1 8 5 2 or 3 8 4 E140 E4140 230 1 Non 7.5 1 or 1 8 5 2 or 3 8 4 BN140 BN4140 115 1 Non 15.5 1 or 1 8 5 2 or 3 8 4 BE140 BE4140 230 1 Non 7.5 1 or 18 5 2 or 3 8 4 SELECTION GUIDE 1. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. 2. Mechanical alternator M-Pak 10-0072 or 10-0075. 3. See FM0712 for correct model of Electrical Alternator E-Pak. 4. Variable level control switch 10-0225 used as a control activator, specify duplex (3) or (4) float system. O CAUTION All installation of controls, protection devices and wiring should be done by a qualified licensed electrician. All electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. _-- -_ _ -----_ MAIL T0: P.O. BOX 1 f~ ~ Louisville, KY 4025ti-0347 Manulaclurerso(.. Zo . ~~ <~; ® SHI oui~ i11e6KY 40211961 ad ~~ IIL/•,1 (502) 778-2731. 11800) 928-PUMP ,Qvaurv Put+as SN~E /9,99 http://www.zoeller.com PUMP CO FAX (502) 774-3624 ________ ____ ___ . c ct F ~- 3 7/B I 6 i/4 a 5/d ~° ° I I ~2 5/H a 5/76 I t SK1524A ~ • • ~ .r l/a Imo- 6 i/a • - 4 5/d o 3 i; a 60 _~- i t/2 - n 1/2 nc. ,v iJi s2 i I -I~-~/-;~ - -,-- 1 _I~I .. ~_. _(._.. __.u_-~_ SK15246 _f __ ..__ .__.~~ L L © Copyright 2001 Zoeller Co. All rights reserved .:, .~ Pa11~7S ~WNER'fi M~IUUAE. & IUTANQG~M~NT PLAN Palle ~_ of ,-,~;._ F~~ -uFa~ns~T} ~,~ Owner Permit # dE81QN PAf~4M>~:'TEH$ Number of Bedraome ~- 3 ^ NA M.,~-.~.r Number of Publle Facility Llnits Q NA Eatlmated flow {avers®et 3C1U al/da Design flaw (peak}, tEstimated x 1.5i 4~U al/da Still Application gate , ~ al/da /tt~ Stattderd InfluentlEffiuf3nt Quality Monthly average " Fats, Oll & Grease iF©G} S30 mgll_ Biochemical Oxygen pamand IBOf~sl 5220 mfllL ~ NA Total Suspended 5ollds (TSS1 x150 mg/L Pretreated Effluent Duality Monthly averafle piochemical Oxygen Qemand (f30t}pl 530 mglL Total Suependtid Solids 1TSSI S30 mglL ~ NA Fecal Coliform Sgeometric metjnl 510' cful100m1 ~ Mexlmum_Effluent Partials Size Ya in dia, DNA ,ether ~ NA `Yaluea typical tar d4meatlc wastewater antl 8epnc tanx essl~n~~ vSeptic Tank Capacity lUUu al ~ NA Septic Tenk Manufacturer Wieser Gpncrete ^ NA Effluent Filter ManuteCiurer ppl laK Ca NA Effluent Filter Modal p>a-525 ^ NA Pump rank Capacity fiUU al ^ NA Pump Tank Manufacturer Wieser ~oncrt.~Ce ^ NA pump Manufacturer;La~ller Yuiup (;n ^ NA Pump Medal 1.4U, ©NA Pretreatment Unh ¢} NA C7 SandlGraval Filter ^ Peat FNter D Mechanical Aeration ©Wetland ^ pisinfection C3 Other: _ dispersal Cell(sl ©NA Q In-Ground {gravity! p In•Ground ipressurixed) ^ At-Grade [7fi Mound ^ prip-L{ne ^ Other: _ Other. DNA ether; ^ NA Other: ^ NA n,yn~l~.nr....~,~--.._.r~-- .. _... Service Frequency Service Event manth{sl {IlAaxlmurtt 3 Years! ~ NA Inspect candlticn of tank{sl At least ante every: ~ !~ ear a? d NA Whan combined sludge mnd sc um equals one-third {Yyl of tank volume Pump out cantenta of tank{sl p month(s) tMaxlmum ~ Years! Q NA Inspect dispersal aell(sl At least anae every: 2 Q year(sl [7 monthl6l DNA Glean affluent ti{ter At least ante every: 13 IA year{al ~-••-~ p month{sl ^ NA Inspect pump, pump controls & alarm At feast onto every: ---°---~ j~ yeartsl -• p month(sl ~--•--~- ^ NA Flush laterals and pressure test At least once every_ 3 year(s) ___r_.~_- -.-~ µ~ ^ month(s) l:] NA Other. At least once every: ^ yeartal ~ r--~- -~ // / II{{ Q NA Qthe-: _ ~~.,~ u..~ _~~ f ~ i. ~~d h k:. t.~~ f i ~ ~. k' (,- u ir.~~ c~ .~ cc~.5r.-~~ 1 ~t'cc~~s' NIA{N7"EN/~NCE IN&r'tiUCTIC#N$ one of the following licenses or certifications: fnepectlona of tanks snd dispersal cells shall be made by an individual carrying Master Plumber; Master Plumber Restricted Sewer, POWTS Insect#or; POW~'S Maintainer; Septage Servicing Operator. Tank (napactions moat lriclude a oleos! lns`J~cteio ndf~cumeand tooatheck'foaany 6ackguprar po d ngdof effluentton the ground surface. measure the volume of combined sl 9 ondin The disperse! ee11(al shall be visuallT InapQndin tofceffl ant anftha ground surface may indicate a fail rag aartditfan and$equ res. the of elf#uent an the Around surface he p 9 immediate notification of the local regulatory authority, Whers the combined accumulation of sludge end $cum in any tank equals one-third (Y,1 ar more of the tank volume, the entire Con1'enCB of the tank sh$EI be removed by a Septage Servicing pperator and diseased of in accordance with chapter NR 113, Wisconair- Adminlatrative Grade, All Other aarvioe*, incfudinA but net limited to the pprvicing o4 effluent filters, mechanical or pressurized apmpanantg, pretreatment unit9, tend any servicing at intervals rat 512 months, cite!! be pdrformcd ay a certlftp~ POW7S Maintainer. .... ....,_.__ ..e ,..-..„..Iet:nn of env S@rVIC9 eV6«t. Page ~ of a START' Up AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s1. If high concentrations are detected have the contents of the tankls) removed by a septage servicing operator prior to use. System start up shalt not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup 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) water; 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 and pits 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, alt tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ^ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ^ 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> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name Hel eson Exc v t' n n Phone 7.15/772-32713 POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Johnson Sanitation Phone Name St. Croix Count Phone 715/3tf6-46~U This document was drafted in compliance with chapter Comm 83.2212)1b111-ld1&If! and 83.5411), (2) & (3-, Wisconsin Administrative Code. ~, ~ a ' Wisconsin Department of Commerce Division of Safety and Buildings ~,-iz RECEIi/Ep APR 0 3 2000 ST. CROIX COSU~NTY ,.._ UATION REPORT Page ~ of ~--~ ce wi „ ~~mm , vv~„ Harn, t.vue nc County e Attach complete site plan on paper not less than 8112 x 11 include, but not limited to: vertical and horizontal referen oint (BM), direction and parcel I.D. [~ / S~~ ~-lQ percent slope, scale or dimensions, north arrow, and location a arest road. Please print all information. a te Reviewed D Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~ / 7 7 Property Owner Property Location t S b Y'C (~ S p (/~ ~ o Govt. Lot (,(~ 1 /4 ~ 1 /4 Sa T ~ ~ N R ~ E (or W © ( Y Property Owner's Mailing Address 1 ~ Lot ~ Block # Subd. Name or CSM# S-~' 2 GD~'S ~ oft'- Q ~ ~ l ~ 7? ~~0 ~~ . , 0 f e~G City State Zip de Phone Number ^ City ^ Village [down Nearest Road [ i1`lew Construction Use: ~'F~esidential /Number of bedrooms Code derived design flow rate ~~O GPD ^ Replacement ^ Public or commercial -Describe: ~~ 77 ~~ Parent material ~ O rS S ©(.~~ h tl_~___ _ Flood Plain elevation if applicable 1~d- ~• General comments ~ S ~ ~ ~ ~ ~ ~ L- -~ /D x ~~s` l~r h /8,~ ~ ~ cQ Leer ~-e~ and recommendations: ~ /n~~ ~~~ Q o~ C ~~ ®~~ Boring _ Boring # ~~ L~ Pit Ground surface elev. _,~S ~ ~_ ft. Depth to limiting factor ~ in. Soil lication Rate i H th De Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DlfP or zon p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 d - ~ ~ ` vv` ! f w t - ~3 SC c sb~ ~ ~ Ivy" i '~ I R,u~.,,, ~ ~ Boring .~. , ,~ / I "' I (~ Pit Ground surface elev. 7Co • aCJ ft. Depth to limiting factor r ~ rn. Sal lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 '~ / ~' ~„~ I r rl . r g 3~ ~- ~° • c b~ , r ' tffluent #1 = tfUU > 3U < 11U mglL ano I SJ >3U < 1bU mg/L - tmuenc r~[ = ow ~ ov nyr~ a~w ~.w ~ w ~~~ty~ CST Na (Please Print) Si nature r CST Number Address to Evaluation Conducted Telephone Number 4 / //~ ITT 1~n1/~ TI~1/IM\ S / ~~ / v .- /+~ 5 Property Owner ~~ Wl ~ ~r~~t S ©pl Parcel ID # Page _~ of Boring # ~ Boring /. Ground surface elev. ~y 9 ft. Depth to limiting factor ~ o (n. mil A ication Rate Horizon Depth Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots GP DffF in. Munsell Qu. Sz. Cont. Cdor Gr. Sz Sh. 'Eff#1 'Eff#2 3 -- L ~. ~s b~ !~-~i- C ~ ~ ~ . ~ Boring # ~~Boring ~ L~J Pit Ground surface elev. ~y 7 ft. Depth to limiting factor _~`~ in• mil A ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft? in. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. 'Eff#1 'Eff#2 ( 3 ---~ 5 ~! ~ s ~. C W f ~ . ~ ~ ~ ~ (.~ ,r ' ~r ~ ,3 -l • ~ 3D~ ~ rr w f ~v9' ~ ~ ~ ~, ~~ 1 C ' I - ~ 3 Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ^ Pit Soil lication Rate Horizon Depth Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots P Dlff in. Munsell Qu. 5z. Cont Color Gr. Sz Sh. 'Eff#1 'Ef(#2 'Effluent #1 = BODb > 30 _< 220 mglL and TSS >30 < 150 mglL * Effluent #2 = BODb < 30 mg/L and TSS < 30 mgfL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) s A ~~ 5 Properly Owner l C'~ Vtil ~ ~~i°~t S ®~ Parcel ID # Page ~ of ~_ Boring # ^ Boring ~j' Ground surface elev. _~~ ft. Depth to limiting factor ~ O / in. Soil A ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DlfF in. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. 'Eff#1 'Eff#2 3 -'~ ~ ~. ~S ~C l~'l-~i- C ~.J i ~ • ~ ' Boring #^-~/Bonng L`7 Pit Ground surface elev. 9y 7 ft. Depth to limiting factor ~ in. mil ication Rate Horizon Depth Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. 'Eff#1 'Eff#2 ( 3 ---~ 5 ~! ~ s ~ ~ C c~ ~ ~ ~ r'v t ,. ~ R 6l~ r r ~ ., ~ ~ -s' ~5 C 1 c '' - _ ~ . 3 ^ Bonng Boring # Ground surface elev. ft. Depth to limiting factor in. ^ Pit Soil lication Rats Horizon Depth Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 =GODS > 30 < 220 mglL and TSS >30 < 150 mg/L 'Effluent #2 =GODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 {R.07/00) . .. ~u.~.r ~ r [~ h~ ~ O re tro S o ~ S: 1 e ~~ ( ~esa ~~Oa~/~ .~.-~ ~ yU i 3 '~' ~~ 3°~3 3 ®-F G, ~4~e- . e_ ~~o~os~~ ~~~ ~-~r~ ~P~~-cal ,~ s d sso' ~1 ~( ~xc e yo ~ /-~s S~ioc.c~~ ~,-~~r H ~~ri~ I3.IH. rt~o.©o ~O,lc~e ~py-q, R.•lobo~. ~',~ y~~ (,vo~dZ P~'E- 9Y~ ~s qs ~.s 9G. 1 ay ~'I , b ~. ~ =~ ~~ ~ ~ga ~ ~~ ,~ ~ I ~~ I s g~ ~` I ~ ~ r {3..11, I Od. C~ -~ ~y~~t~oa~ ~ bo~ L 8'968 ~ VOL 21 PAGE5242 xATALEEA H. REGISTER OF DEEDS ST. CROIX CO. WI RECEIVED FOR ~{ECORU 0%/14/2006 03:05P11 CERTIFIED SURVEY MAP CERTIFIED SURVEY MAP Thomas and Arla J. Sorenson Located in the Northwest '/. of the Northwest '/, of Section 24, Township 28 North, Range 1 S West, Town of Cady, St. Croix County, Wisconsin. N BEARINGS ARE REFERENCED TO THE NORTHlINE OF THE NORTilINEST 114 OF SECTION 24, T ?8 N, R 15 W, ASSUMED AS S 89°Ies'18' E SCALE OV FEET 1 • ~ 300, O• 1 1 0 2 0 ~' ~ CL j ~~ ~ sZQ~~ NORTHWEST CORNER ~~ 6~6'~ SECT/ON2<, TTBN, R 15W ~: ..1: ~~~ ~ ( {FOUND COUNTYBERNTSEN SURVEY NAIL ~~ ) y_l ( L - . _ Fo _ NO~~ ~o ~ ~ ~" - 53 656.96' -~- ~, LINE - - - LOT3 i~ tO ~ c? ~ W~ DWELLING ~ W/GARAGE I ~ i ~~~jjj 0 ~ ~ a`t ~~'~~ o~ _ . _ _. °_ _. .4~ , ~3' ~~ LOT 1 2 ~ ii ~~I 3~" ,~ soo,esl sq. Fr. , w OR 13 789 AC ~ . . ~;I ~ (550,171 SQ. FT. OR 12.830 AC. EXCL. TOWN ~ ~ ROAD RIGHT OF WAYS) ~' - ~ I g ~- ~ ~G ~. ~, , W . ; m z; g ~ .. % ~ ~ ~ ", s as9~o 1s W ~ ~ ~~ ~ 8 e H ~~ I Z N Z• w l N 87°32'15' W 526.2T ~' ~, iI t I ---t 1-. ~i ~ ~: i L COPY FEE: 3.00 PAGES: 2 LEGEND ~ INDICATES 1' O.D. x 18' IRON PIPE SET (M/N. WT. - 1.13 LBA.F.) D SO/L BOR/NGS (PROPOSED SEPTIC SYSTEM) 0 SECTION CORNER MONUMENT (AS NOTED) -+- INDICATES FENCEUNE QWNERS ADDRESS 277 320TH STREET WILSON, WI 54027 11/VPt ..4 ~7'~Q_4.~4/11D,S TS 89.48'18' E 2839~84'~ N NOTE- ~ LOT 3 CONTAINS 19~ 915 SQ. FT. OR 4.544 AC. (185,122 SQ. FT. OR 4.250 AC. EXCLUDING TOWN ROA per' RIGHT OF WAYJ W WESTIN CORNER lIIYP~4_T_T_ ~D _~A1_~IQ~ I NORTH 1k CORNER ~ SECTION 24, T 28 N, R 15 W (FOUND 1" IRON PIPE) S 89°48'18' E 1319.92' ~~~~ ~\ - - ~ ~' 1~ LOT ~ 939,87 Q. FT. ~ 1.576 AC. ~ v~. (918,954 SQ. FT. OR ~ '~' 21.098 AC. EXCL. TOWN v ROAD RIGHT OF WAY) "' t] ~ ~ r- 0 RECEIVED (~ z ~: ~~'~ ~ ~~ j , j , ~ ~ w7Vy~ /~ -1284.42' - 785.25' SOUTHUNENWI/4-NWJ14 ~' W 1318.43' ~ UNPI~4TTEQ _C1LYP~%4_T_r~Q.1~4NQs ~ ~AAlvP_s SECTION 2<, T 28 N, R 15 W DATED: SURVEY NA LNTY BERNTSEN MARCH ?Z, 2006 THIS JNSTRUMENT DRAFTED BY JERALO L. CARSON 1 of 2 Vol 21 Page 5242 T - MIJRE~ ~e * ' S 1713 . ~ ELOENVILLE. ~ ~ WI. : A t9 : J~ • ~ e ~ ~~ LAND SHEET 1 OF 2 Parcel #: 004-1055-60-100 03/27/2007 05:04 PM PAGE 1 OF 1 Alt. Parcel #: 24.28.15.376A 004 -TOWN OF CADY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 08/09/2006 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O - SORENSON, NATHAN A NATHAN A SORENSON N403 FOOTE AVE SPRING VALLEY WI 54767 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 13.789 Plat: 5242-CSM 21-5242 SEC 24 T28N R15W PT NW NW CSM 21-5242 Block/Condo Bldg: LOT 01 LOT 1 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 24-28N-15W NW NW Notes: Parcel History: Date Doc # Vol/Page Type 11/14/2006 838815 WD 07/14/2006 829687 CSM 07/23/1997 958/45 07/23/1997 880/483 more... ~nn7 cl IMnAeRV Bill #: Fair Market Value: Assessed with: Valuations: Description Class Acres 0 Totals for 2007: General Property Woodland Land Improve Last Changed: 08/09/2006 Total State Reason 0 0 0 0.000 0.000 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category 0 0 Amount Special Assessments Special Charges Delinquent Charges Tota I 0.00 0.00 0.00 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT Owner/Buyer AND _ (~ ~ OWNERSHIP CERTIFICATION FORM Mailing Address N ~b ~ ~o~ ~y~~ ~-, ~~l(~_~ ~~~ ~ ~ 767 Pronertv Address .~ 2 I I ~0 ~ /~-^l''~ ~ .. (Verification required from Planning & Zoning Department for new construction.) City/State ~~~~~w~ (~~ Parcel Identification Number ~~{ - (pS S ~ Co U - oo y LEGAL DESCRIPTION Property Location ~ ~J `/ , IUIJ '/ ,Sec. of 4 , T ~N R 15 W, Town of ~ u Subdivision ~ /A Lot # i Certified Survey Map # ~j ~ ~ (p Q ~ ,Volume 2 ~ ,Page # ~L-y L Warranty Deed # ~ 3 ~ ~ 1 `~ Spec house ^ yes ~ no Volume ,Page # Lot lines identifiablef~ yes ^ 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 §Comm. 83.52(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 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 Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. Uwe 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 ~/ ~d ~ S G TURE OF APPLICANT(S) 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. 08/05) 838815 STATE BAR OF WISCONSIN FORM 1 - 2000 WARRANTY DEED THIS DEED, made between Thomas N. Sorenson and Arla J. Sorenson, husband and wife, Grantors, and Nathan A. Sorenson, a single person, Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (the "Property„): Lot One (I) of Certified Survey Map filed July 14, 2006, in Vol. 2l of C.S.M., pg. 5242, as Doc. No. 829687, being located in the Northwest Quarter of the Northwest Quarter (NW%./NW'/,) of Section Twenty Four (24), Township Twenty Eight (28) North, Range Fifteen (IS) West, Town of Cady, St. Croix County, Wisconsin. * Arla J. S nson Name and Return Addres • ~ Loberg La ffice W1~N6IN t32IDTT i)11i0N 359 W ain Street 860 (fig ~ pp$ 136 >cllsw h, WI 54011 ~~~~ 4JI 54002 Together with all appurtenant rights, title and interests. 004-1055-60-000 Parcel Identification Number (P1N) This is not homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easements, covenants, and conditions of record. Dated this 31" day of October, 2006. * Thomas N. Sorenson AUTHENTICATION Signature(s) authenticated this TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) , TiiIS MSTRUMENT WAS DRAFTED BY Law Office (Signatures may be authenticated or acknowledged. Both are not n6~ "Names of persons signing in any capacity must be typed or printed below dp/jb SST6153 ~au~tuttw ~~~~~~¢~G1A CO •QP• 03Aiq ~c ~ ? ACKNOWLEDGMENT STATE OF WISCONSIN ) COUNTY OF ST. CROIX ) ss. Personally came before me this 31"` day of October, 2006 the above named Thomas N. Sorenson and Arta J. Sorenson to me known to be the person(s) who executed the foregoing ~t[s~jrument and aclmowledged the same. *. Nc KATHLEEN H. IiALSH REGISTER OF DEEDS ST. cRUIx co. , 1iI RECEIVED FUR RECURD 11/14/2006 03:15PM MARRANTY DEED EXEMIRT # REC FEE: 11.00 TRANS FEE: 207.00 COPY FEE: CC FEE: PAGES: i Recording Area St. Croix County, State of Wisconsin ~ is permanent. (If not, state expiration date: 8~..\`-9 1 of 1 WARRANTY DEED STATE BAR OF WISCONSIN FORM No. I-2000 8 c 9 6 8 7' VOL 21 PAGE5242 KATALEEN H. REGISTER OF DEEDS ST. CROIX GO. MI RECEIVED FOR ~tECORD 0%/14/2006 03:05Pl1 CERTIFIED SURVEY lfAP PAGES: 2 CERTIFIED SURVEY MAP COPY FEE: 3. Thomas and Arla J. Sorenson Located in the Northwest '/. of the Northwest '/, of Section 24, Township 28 North, Range 1 S West, Town of Cady, St. Croix County, Wisconsin. N BEARINGS ARE Rt~ERENCED TO THE NORTH LNG OF THE NoRn+wESr 114 OF SECnoN zs, r2a N R 1s w, Asr;au~ AS S 89'46Yd• E scALEavFFEr 1.•9on. LEGEND ~ /ND/CATES 1"O.D. x 18'IRON PIPE SET (MIN. 6YT. - 1.13 LBJL.F.) D SOIL 80R/NGS (PROPOSED SEPTIC SYSTEM) ® SECTION CORNER MONUMENT (AS NOTED) -•- INDICATES FENCEUNE 1~~ 7 1 0 2 0 ~ Z; .¢¢ ~ ~ NORTHWEST CORNER ~ s s~ sECnoN z~, r26 N R 1s w (111jP1.f~ ~TEQ_tn..4NQ,S J! ~; ~ (FOUNDCOUNTYBERN7SEN ~ ~ SURVEYNAlL) q~~~//.,~~ .L'r<d=L ._ io y; J ~ L _ - S 89'48'18' E 2839.84' - ` - ~. - .0 _ 1~ ~. ~ 656.98' -~- - - ~ - ~ 63: _ •4 ~ _ ~, UNE - - - ~" ~ ~ LOT 1 3 ~ 800 651 SQ FT ~~ , . . 1 OR 13.789 AC. w~ g I (550,171 SQ. FT. OR b '- • ~' 12.630 AC. EXCL. TOWN ~ ROAD RIGHT OF WAYS) "' 1 ~. I ~ m ~~ 2; I ~ 3 ~ ~ I 18 d a ~ J Z ~ N 1 ~ ` N 87°32'15• w s26.2r ' =' 32.59' 493.89' s 6 ~ 6~ LOT 3 ~ Z 1I 0 wECI. ~~ ~~ I ~ W/ GARAGE , i ~ - ~ ~ - b ~ 18' AREA ~ 34 01' 533 . . 499.1 T 2 . ~ NOTE - I I LOT 3 CONTAINS 197, 915 SQ. FT. S~ OR 4.544 AC. (185,122 SQ- FT. OR ~: ~ 4.250 AC. OCCLUDING TOWN ` gam' RIGHT OF WAY) F-~ ^ W = WEST 1H CORNER owrtERS AvoaESs 277 320TH STREET Vi/ILSON, W( 54027 LOT2 939,872 SQ. FT. OR 21.578 AC. (918, 954 SQ. FT. OR 21.096 AC. EXCL. TOWN ROAD RIGHT OF WAY) D ~ D 'mss ~~ ~~s -1264.42' - _c1AlP~-_~~4~.4~-~!t?~ I NORTH 1/<CORNER SECTION 2<, T 28 N, R 15 W (FOUND 1' IRON P/PEj Yo ~'- - - S 89'46'18• E 1319.92' u~i ~; 3 o a, 8 ~~, ~318.a ' UNPI~4TTE'Q t~NP(~4TT~D1~4N_QS ~ ~NQS SECTION 2<, T 28 N, R 15 W DATED: (FOUNDCOUNlY8ERN75EN MARCH 22, 2006 SURVEY NAIL) rHIS INSTRUMENT DRAFTED BY JERALD L CARSON =gpONg: ' • MORE H, EE •. ~ • S '1713 ELOENVILLE,~ WI. . ~ W ••, •_,~ ,f~~ J \ ~~ L.4N~_ S SHEET 1 OF 2 to12 Vol 21 Page 5242 O..`~.. ~p~-~S o~ ~. ~ ~~s ~~~-z3~1~ Y G~ ~oc.~~ N ., ~p Tb C'D ti ~ 3~'' ~, -. _ .~~ ~ ~c~ roo ,.--, ~ ' 1 ' ~ ~,a s~~,~ ; y ~~ '~ zo ~r t ~~ ~ l~ y4 3 _ ~ ~ ~'c- a a az. ;, 1 i3e rAp w. ~` r' 1 ! GI° ~ ' ~ ~,f~~ 3..... ~. 1 ~G V' ._ -- ~~ ~ a. I ~1 /{-,c ~~ I_ ~ ~~ ~ ~ -- ~_ St FT• 8 '~ ~~ ~ ~~ ,Q-~~~- l ~, . . T _._ I ,, 1 _ S~,° . ~ D 2~P ~~. --' ~; ,r ~~-~ :_ ~ ~ ~ ~ ~ _ ~ s ~ ~, ~~ .:~ ~.~ ~ ,~ ~.: i *, ,~ ~, _.. '4 ~_ ~a ii 7~ LL' N FTH ~} F ~'~ t-}Q-,gyn. c= (sa t ~tiZ' T2{ vt-i-T'cxt t S N~~~ G/~LL ~ 6LUt~77~NS. (~~ ~~