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004-1070-50-000
St. Croix County Planning and Zoning Friday, February 16, 2007 at 8:35:40 AM Detail Sanitary Information Page 1 ojt Computer #: 004-1070-50-000 Sub/Plat: 40 acres Section: 29 Parcel #: 29.28.15.465 Lot: TN/RNG: T28N R15W Municipality: Cady, Town of CSM: 1/4 114: SE 1/4 SE 1/4 Owner: King, Rex M. 120 290th S treet Spring Valley, WI 54767 State Permit: 487978 Issued: 11/07/2005 POWTS Dispersal: Mound 24" or more suitable soi Permit: Replacement County Permit: 0 Installed: 11/30/2005 POWTS Detail: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspector As Buili Plumber Other Reouirements Additional Nates Money Owed Kevin Grabau >4/1/00 -Not Required Dahms, Brady Brady didn't even pick up permit card or paperwork $0.00 Ryan Yarrington Yes for owner, so will mail 2/16/07 6~aintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 11 /30/2008 Owner: King, Rex M. 120 290th Street Spring Valley, WI 54767 State Permit: Issued: POWTS Dispersal: NA Permit: Replacement of Tank County Permit: 0 Installed: 11/03/2004 POWTS Detail: NA Bedrooms: 4 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspector As Built Plumber Other Reouirements Additional Notes Monev Owed Pam Quinn NA Mittlestadt, Tim 10/29/04 -Received an emergency call that a tank Not determined ~€ ~ No had been damaged during basement waterproofing and needed immediate replacement. Mark Iverson inspected tank(Huffcutt 1250/750 combo) and obtained measurements to be added to future replacement system - no fees were paid yet. Tank service agreement from owner/pumper - receipts, too Original application with fees for tank replacement application/inspection ($150 + remainder for mound system) Application & plans for mound replacement system + soil report from Henry Grote .See Brady Dahms permit ~F eEA~p-CF w~tu`~ Sr• Ctctx COUNTY SYs~ NO. 487978 STATE SANITARY PERMIT ^T _ EWAL PREVIOUS NO. OWNER ~.EK ~wC~ PLUMBER $¢+apr P~.,~I+E~S LIC.# 22o3sS" TOWN OF C~~Y SEC 2`~ ,T ZS N, R 15- ~~~ AND/OR LOT --~ BLOCK ~lo,~ ~-~.~~ SUBDIVISION CHAPTER 145.135 (2) WISCONSIN STATUTES (a) The purpose of the santary permk is to allow installation of the private sewage system described in the permit. (b) The approval of the sanitary permk is based on regulations In force on the date of approval. (c) The sankary pernk is valid and may be renewed for a speckied period. (d) Changed regulations will not impair the ralidky of a sankary permk. (e) Renewal of the santary permk will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (f) The sanitary permk b transferable. History: 1977 c. 168; 1979 c. 34,Y21;1981 c. 314 Note: H you wish to renew the permit, or transfer ownership of the permk, please contact the county authorky. ' _ AUTHORIZED ISSUING OFFICER -DATE JCJD~. ~+ ~.S_ THIS PERMIT EXPIRES IUd~. o ~, ?.~~ UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (R.8/00) Wisconsin Depaitment of Commerce Safety and Buildtr~3 Division GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) 'ersonal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] 'ermit Holder's Name: City Village X Township Kin ,Rex M. Cad ,Town of SST BM Elev: Insp. BM Elev: BM Description: l 6C~ ~~ 1 GS TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic /-~~~, ~- 3 ~ ~ ~ ZSb Dosing Ca ~ ,~ SQ Holding. . ,.~~,; y TANK 'BACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic 7 50 ~ 7 /Cl~ ~ ~ $~ ~ ~ ~ ~ -. Dosing .7 ~ ! 7 /~Q / ~~ ' /g i r Aeration Holding PUMP/SIPHON INFORMATION Manufacturer nd D Qe'le~ PM Model Number ~ ~~ 25 • ( TDH Lit~ ~ FrictionSLos~ System ~ a5 , TDB 5 0 ~Ft ~ / Forcemain Length / Dia. ~ ~ Dist. to Well ~ 7 /~o 2zb z SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 487978 0 State Plan ID No: Parcel Tax No: 004-1070-50-000 Sectionlrown/Range/Map No: 29.28.15.465 STATION BS HI FS ELEV. Benchmark 3 ~$ /b~ ~~ /~ Alt. BM F~~ ~~, ~ •~ iaa ~ Z Bldg. Sewer eC St/Ht Inlet D St/Ht Outlet ~ Dt Inlet ~ \ Dt Bottom ~ ~ ~ ~ 4Z ~ $ Header/Man. ~~ ~ ~ /a ~ ~ 5$ Dist. Pipe ~ ~ 5 /~ f ~ 5$ Bot. System Z 2~ ' /~yr Final Grade ~~ 5 /~Z 5,$, St Cover ~,1 Co Z coq / ~ ~ Z Co~vr- 3•~~ ~ bb BED/TRENCH Width I Length No. Of Tre hes PIT DIMEN I$ ONS No. Of Pits Inside Dj~ Liquid Depth ^ DIMENSIONS ~ /~z•6J L ~ ~- \ ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: ~_ RMATION INF CHAMBER OR O Type System: ~ sb / 7~~ ~ 7 /~ ~ _ I /~ , r F~ UNIT Model Number. ~ a ~ DISTRIBUTION SYSTEM fCe~X Header/Manifold t Distribution ~ t Pi ' ' x Hole Size ~/ / x Hole Spac~ g Vept to,.A.tirolntake f "- Length~_ Dia_ pe(s) z ~ Length ~ / ~ Dia Spacing 3 ,/~~(J ~ C~+4 ~~ SOII COVER v Prncm~rn R..c-cmc n.,t.. YY Mnunrl nr Af.Grade Systems Only Depth Over r Depth Over xx Depth of xx Seeded/S de xx Mulched Bed/Trench Center I ` ~' Bed/Trench Edges \ Topsoil 1 1~ \ ~` ~ Yes !, ~ No ~ i es ~ 'i No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ r~~ / (~]~ ~ Inspection #2: / /_ Location: 120 290th Street Spring Valley, WI 54767 (SE 1/4 SE 1/4 29 T 8N R15W) 40 cres of ~.VV~~C,, ~ rcel No: 29.28.15.465 1.)AItBMDescription=,~'.~~ COJ~ ~5'~ct~~~ 6 ~~~~ PIO,,,v 2.) Bldg sewer length = 7 P~ bv.~ ~`~ - amount of cover = Jg ~~~~~ ~ 3~Z OVA. I ~ 5~ -,. ~7 o, ~7 Spa,. /~ni~, Plan revision Required? ~ j Yes ~ , No I- `~ i ! :{ (~ I Use other side for additional information. ,_L~ J_~!.~ ~~ !_-- - --- ~ ~. ~ L`~- - i Date In epctor's ure Cert. No. SBD-6710 (R.3/97) S><ftxy uld Buildit>,~s Division County 1 W W `~ ~ • ` . uhit>Ytoa Ave., P.O, Box 7162 ~ ~ ~~ ~sc®ns~n fin' De artment of Commerce ( ~- ,,,~~~ tirY t Number (to be flllod In by Co.) g~- `~~-S' Sanitary Pe A ton S P<an .Number la atxord with Comm 13.21, wla. Adm. on you Pro~id~` '` ~nU5 //s~itf (~" %~ d 1 ~~^ S T~ Q ~ may be used for seeottdary purposes Prly Law, lXm) / , nuiline address) L Application Infocmatloo -Please Print All Information ° ~~~ZONING fJFFICE 1 ,a..n0 -~~"~~ ~ Property O.mer's N the Parcel r-+~ L~oti~---' Baesk-Y_ 'PSc ~~ -10~-5~ _~ . Pttspvty Owoet's M iilini Atidreu Property location G u , ~~ 1i ,Suction Chy• Stau Zip Code Phone Ntunbu .~ ' t./l ~y7G cucle~ T~ N; R~E orr~LWWJJ d uildlne ( k all that aPP1Y) ~ 1 or 2 Patnlly Dwclltn= - Number of Bedrooms S CSl~.y>~r ^ Public/Commcrcial -Describe Usc ,O p ~[~¢. p,,~ O State Owrod -Describe Uae ~ - ~~ IIee OCiry_ Vi11aQe„extownship of 4 ,,,~ ~- m. Type of Permit: (Check only one box on line A. Complete Une B If appUcable) A' O New S um yes ~ Replacement System ^ Trcatment/Holdin~ Tank Replacement Only ^ Other Modiflation to ExistinY System 8. ^ Permit Renewal ^ Permit Revision ^ ChanYc of ^ Permit Transfer to Ncw List Previous Permit Number and Daa Issued Before Expintbn Plumber Owner t N. of POWTS S item: (Check all that a 1) K /2 , S- _ O Noa -Pressurized UrGround ~ Mound > 24 in. of suitable soil O Mound < 24 in. o(suinble soi O At-Grade O Single Pus Sand Filar ^ Cortitructed Wetland ^ Pra:urizod In-Ground ^ Holding Tank ^ Put Filur ^ Aerobic Tratment Unit ^ Recirculating Sand Filar ^ S tsthetic Modia Filur ^ Leachin Chamber ^ Dri Linc ^ Gravel-less Pi ^ Other (ex lain) V, rteatmeot Area Information: Desi~ Plow (jpd) Daisrt Sotl Application Rate(Ypdsf) Dispersal Area Requir (st) Dispersal Ara Propos st) System Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Galbtts Gallons of Units Cortereu Comtructed Glass New Eaiuitti ~ TWu Tanks Septic a Hoidini Tank ` x ~~ Aerobic Treatrr,err Unit Cwambcr ~ v t.., .~ ~~, VII. bWty Statement- 1, tbs undersl~sed, assume responslbWty for instailatloa of the P01YI'S shown on the attached plans. 's Na the (Pritu) Plum 's Si Qrtature /MPRS Number Business Phone Number ~,~ off! ~~o~~- pis-a.~s- cis r Addre u (Street, Ciry, Stau, Zip C c>ao ~ ,~~ ,~e ~ 1 S y ~ ~ VIII. Cotsn /De ant Use Onl Approved ^ D' ovod Sanitary Permit Fee (yscludes Groundwater / ~ Dau Issued issuing Aecnt Si~rtaturc o Scamps) Surcharge Fee) ,`{ ~ ' ^ 've n for Denies) 2S"-' ,~ ~ ~ ~ ~ 2vd IX. Conditiotu Ap rov .{~ ~ SYSTEM 3 ~ ~e~t.cS 5 l~.~vv 1 Septic tank, effluent filter and ~ , dispersal cell must all be serviced /maintained ~(~ ~ S y~,~ ~ ~ as per management plan provided by plumber. / -i--- 2. All setback requirements must be maintained e,ti ot,d ~" Le~ as per applicable code/ordinances. ~--- -- wttacD comptets plant (b lbe County otUy) for the sysltm oo paper out Ieti ILaA ill x 11 Iowa la sue SBD~i398 (R. 01/03) ~, ---, w ~ ~~ ~,-~, , S C. o„l ~ 1 y ` = ~ ~` .. ~ \, ~ t , /~-~W Get zzz~-~~ ' (~ Q ~\ ~~ Y °'1 ; ""~"'~ ~-~\~ 4~ Sw~~r~~ SL - SL'-Zc(-Zg-\~ ~ ~a ~~", ~ S~. ~e ~ Nl (~ao~n ~ pro . o~ .. ~ ~ ~~e o~ 5~.. ~~ s~ S~~e N n g ~ S Q~ ~ ~ ~~~ ~,. o~ ~,,.~ ~-~ o~ \z~ ~., s. v... k ~s O ~t ~ .,,, @ a ~. g z3 04o z~~ ~~~~ s~, ~~ e,~-S N .b> ~~~/'/%/ / 3.s~ ,~ ,; ~ ~ b ~.o ~~l ~ y ~~ / ~ ~ _ - ,/ ~'~ rS M ~ I L 1 v-o,. o c,o ,..,,~,,o ~~-u-•. .o`N~riall~ ~~ ~E~N~ ~~p~~~ of ~ gV1~ °~a°'~ ~ ~,c,~ p~ ~R~SpaNp~ SEA G ~~ x(\2.5~ r~~~~~-mac f ~~ St o~ ~~ ~c~ o~ ~ g-o, o u,.,, ~ ~ o ~p r~l ~ ~! ~'\ v ~ ./~ ~ ~ (qa,~) r ~ O~~'~ (fie. •S °~ 6 Y3 , ~I /I 3 - V b ~~ ~,~, commerce.wi.gov isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.wi.govlsb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary July 18, 2005 CUST ID No.220355 BRADY DAHMS HALVERSON BROS 1020 N BROADWAY MENOMONIE WI 54751 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/18/2007 SITE: Rex King 120 290TH Street Town of Cady St Croix County SE1/4, SE1/4, S20, T28N, R15W ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 Identification Numbers Transaction ID No. 1154417 Site ID No. 701820 Please refer to both identification numbers, above, in all corres ondence with the a enc.. . FOR: Description: 3 Bedroom Design Object Type: POWTS Component Manual Regulated Object ID No.: 1029676 Maintenance required; Replacement system; 24 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 -Version 2.0, SBD-10706-P (N.O1/O1); Zabel A-100 or Orenco FT-0822-14 BA 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 approved plans and with the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems Version 2.0" SBD-10706-P (N.01 /01). • 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). A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to corfimencement 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 Q ~) shall relieve the designer of the responsibility for designing a safe building, structure, or component. BRADY DAHMS Page 2 7/18/2005 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, Dennis R Sorenson Wastewater Specialist ,Integrated Services (608)785-9336, dsorenson@commerce. state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 ~I Rex King -Mound Construction Materials and Techniques All materials must comply with Comm 84 and be installed in accordance with manufacturer's specifications. Construction methods must comply with the following Component Manuals: ~ , ,~ y r..l i `1 ~,~~Q Mound, SBD-10691-P (O1/O1) ~~~'~ Pressure Distribution, SBD-10706-P (O1/O1) ~ ~' ~00~ S Location~~ e ~' SE '/4, SE '/a, Sec. 29, T 28 N, R 15 W ~j~` Town: Cady County: St. Croix Date: July 19, 2005 Owner: Rex King Address: 120 290' St. Spring Valley, WI 54767 Plumber: Brady Dahms Signature: i~-~ License: MP 220355 Attachments: SBD-10577 -Plan Approval Application .O S SBD-8330 ~ ~Onatt~ ~,~ v~p Page 1: cover ~~~ 2: design criteria & calculations ~~ RS~,AENS ~F app `~~~, 3: plot plan pEP 4ES`t~ 4: system cross section ~ ~gtoNOF SA ~~_ 5: plan view, lateral detail ~,,~~ ~, ORRESPpNp~NCE 6: pump tank exit detail g~E 7: pump curve 8: system management page 1 of 8 Design Criteria L'~ Residential Wastewater Contaminant Load; 30 mg/L < BODS < 220 mg/L Anticipated septic tank effluent 30 mg/L < TSS < 150mg/L Fecal Coliform > 10,000 cfu/100 mL Fats, oils, grease < 30 mg/L Z _ Bedrooms x 100 gal/bedroom/day x 1.5 `~'~~ gallons/day hydraulic load Design Calculations In situ designed loading rate d ~ Zq gallons/sq. ft. per day Depth to estimated high ground water ~~ z-4 in. Depth to bedrock ~ G"~ in. Cross slope at system ~ ~ ~ % ~ ~v Force main length ~3 o ft. of ~ in. Manifold/header length ~~'~ ft. of ~' in. Drain-back ~ ~~ S gallons Lateral length ~ @ s S ~ S~ ft. of ~ ~~ 2 in. Lateral elevation ~ ~ t ~ S( ft. @ bottom of lateral Lateral hole size ~~~ ~ in. @ 3 b- o in. ( ~ • ~ ft.) Spacing ~ ~ holes/lateral 3 g holes total Lateral volume ~ °~Z~ Z gallons Total lateral discharge rate 2~ ~ ~ $ gallons/minute @ z- s~ ft. head Network pressure compensation losses ~ ~~-S~ ft. Elevation difference ~ -~ ft. Friction loss ~• ~. ft. @ ~ S gallons/minute Total dynamic head ~ ~ ~ ~ s~ ft. Pump/sip'~ion 4 ~ gpm @ 2 ° ft. of head Manufacturer ~ ° ~ ~ ~~ Model # ~ 5 Z Dose volume ~~ R ~ S gallons Lift/sign tank ~ w~ ~ ~ ~~ `z'-° X1-0 ~ ~-~ ~~~ gallons Septic tank ' ` ~' `' ~ Zap gallons Effluent filter ~ r ~~ ~ ~ ~ g Z ~ ~ ~ '~ h ~`° ~- ~ b ~~ Measurement pump on and off ~' ~ in. Height alarm from tank bottom ~ ~ ~ ° in. Reserve capacity ~bd, ~ gallons specs.calcs.res Page ~- of ~ h 1~,0 ~~~~~ S~. __-~, ~ ~ l ~ r ~ `~ e ~ ~-l 1 -1 N ~ ~\ , y ~~ l ~ ' 5~~,~~ T @ ~ ~. g (~a~ CG '.Z.O ~~ -~ ~M ~ °~8 z3 0' 2" Swc s~ TJ4CQ lM O.~v. ~.~ w.C,~ ~~ . urid~~° `G~ ~ of ca98v~~os ~M~W ~ ~~pPR~ ,pE~` ~ ~'-`~~~ PpNp~NG \ GO~~~cs ,5~~ ~~ ~ i , ` ~ ~ S l O y1.Q Q. ~ ~-o l~ o ~ I ~ r 4--~o Iy J~ `J ~T,^~lp \~ _ ~ ~ h p SL - SL---Zq-Zg-\~ •~ `ro-~ ~ ~, C..~. ~a ~~, ~ S~. `~ C~ ~-l (~o~n \ Irv , o~ - ~ C~ bye o~ ~`.. ~ s~ s~~e ~ ~ g3 sQS~a~~t ~ o~ ~~ o~ ~z~ a, s;~ ~ ~-~_ ~, ~9 a. ~~ •s ~ b ~ //'' CS t~ 3,0~ ~ I ~,~~ 6 ~~~ ~~ ~0~~'~ l~••e. ' _ __ ~~ ,. J. ~5 ~4~~~ ~ wv q; S . .S t Q, ~..~ ova ~~ ;. ~ ., ~ OG (\ ^ f CM ~t1~ ~a.o .~ 4.~e Ovt w ~"'~-'G t~~w .Q '" f ~.t7~ \ ~ ~ypl..v lVr ~...TV.) (~ 1 0 l ~~ / O \ „~ Q 1 ~'C GN , \ O l, o ~ tStr.~ ~o + o,p t~ •~ 1 1 l o` l l Z` ~~~ ~ \ ry w.•~ ` ~ b s..~co:1 i«~ o.v ~.~ l ~9ti9 , 0 3~~ d `^~~v ? ~` i `~ z~ ...; ....._ .. I ~ J i C l ~~Z tw~c.~.~a~41.~, t ~• ~ X1,1 ~M ~ ~ ~ __ w. - - .i ~_ ~<<~' -.,, Io,~ ~ `t12,~'~ 13Z.~ ~• '~ ' Z ~- p ~, ~ ~ ~ l~ v C. c, ...~ y~ t of l r\ l (" U ~ b S cir ~r .~ ~f-~ Oy ~... a.. \ ~ L ~ ~oO~ o ~.-. o } Y o ~1` ~ ~ ~~ ~ ~ ~ ~~ ~~ ~'~ $ ' ~ Zl,~ ~~ _.. ~, ~ ' ~wVM \ v/ ~••~•T1. `~ o~.~ ~S' Z P uL s..S. 40 ~o ~.. t „~...:. ,., ,~ ~, 2 P((~+ ~ c ..~ 4v a+L av.,Q ' I I SS. S ' ~ ~- S S S lt~.~' „ ( ~~ i ~ ~ o~ ~ ~ ~ a~ ~ 3 g ~.o~.~ ~~~ zs.~g O'er ..: v ..,~O.w~ ~~,~ ~ ~~~ ~o~ ~ ~~ ~r ~.1v e bo h S~ ~ ~ -LOCKING~GOVfiR ^--~ Lv,4i,~N ~N~ ,c ~BE~ , a~ItK Ot~C.o~VtGT--~ c~ ~~ y ~4 (~Y~ ~~~~ ~ ~ 4° PIG6 3' no NOIS1ua8~D - SDIL. 24`' Z.~. MA~-101E .... i~u r rc~ dw a.avLo A 2~. 0 ;. RI,L PtlG 4 p ~AIQ,W~I ----mac-- 2„ G o 1~(A1 E LT I O KS ~ `'^/ 1~ `e~ ~ .~, ~ - ~ U'O`` ~ ON ~- ~ ~, q ~ c Y m ~ ¢~ao acs 2. ~ . r`-6 L~tZ.~14 t5A 0 ~,~ ~~~ - ~- 1 2 ~~ ~on~~ Mn~N WEATNERPRO~F n JLNCTiON f~ jii,7i'7,; i ,~ C". 4 0 `~`~ _; 4, --.1 `` .. ~, r.,,~r. ~.N~ i ~ , i~ ~ '~ ~~ 3'ow-c J-.;,utiC /I ~, `~^ J I i i I PwyP I I i co~~~ f ~ b~oGK t i i ~tl,~ _ 1"~..~~ ~j~ SCPTiC t SPECIFI~GATIOIJS Dosc ~ 'yw~~~~~ T~u.S MAUUFACT ` ~.~~ f~ URCR: IJUMBE R OF DOSCS: ~'S TA1.1K SIZC; ~Z~'b'~"~ GALLOIJS ~.DOSC _vEK C.._- VOLUME t~ ALARh~ l1iWLFAC7URCR; S `~ `T` `'~-~~~ IAJCLU011Jf, 6ACKPl.OW~ ~ `~ /'~ODCL 1JU-hdCR: • 1 ° I ~'} ~'`~ CAPACI TIES; A- ~'~'~ I-JCHCS Ott 4~0°`fi ~wITCN TyPf; ice"" `~`~ ;,~__,:,_ 34.14 B= Z" lu Zzo av GuMV MA-JUFACTURCR: ~,,_ _ _ cks oa ~'~ O ~~ MODEL UUMDCR: ~ Z Ca iUCMES OH ;,,,__~~~_ ~' 1SS'b3 D ~ JWITCH T!lPf; ~MQJr...~v w ~ INCHES GR v A . _ .. -~ uor~' M 2S ~ PUMP A1J0 ALAR/1 ARC TO DC It\11MUM OISCHARGC RATE ' GPM INSTALLEp 01J SEPARATC CIKC.. ", VORTICAL DIFFCRCIJCf DCTW[CU PUMP Oif AUO OISTRIDUTIO-J PIPE., g`~ FEET + M~uIMUM uETWORK SUPPLY PRCiiURC .~ 2'S~ FLCT'~ ~'}~ ~ .. + 230 FEET OF FORCC MAIN X 1_.3~ F~ ioorcFRICT~ou FACTOR. _ ~ ~S~ '~ FEET ~ f , _ __\ ~ ~ ~ TOTAL. D~-JAMIG HEAD = 1'35 FEETU • '~ IIJTER-JAt, DIME1JbI0AJFi Of TA1JK~ LE.I.ICs7N ~WipTFI /. ~ w `I7 r.~,.r ~ LIQUID DC PT H ' t'am` 6 „R ~? ~r } ; ,, TOTAL DYNAMIC HEAb/CAPACITY PER MINUTE EFFLUENT AND DEWATERING a w x v a z r 0 a ~- 0 o~.soe 0 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available. • Electrical aitemators, for duplex systems, are available and supplied with an alarm. • Variable level conVol switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Qwik-Box available fol'outdoor installations. See FM1420. • Over 130°F. (54°C.) special quotation required. 152/153 Series ._________ 1521153 MODELS _ Control Selection Model Volts•Ph - _ - ~ Mode Am s $im lex Du lex _Nt52 tt5 t _ Non 8.5 1 2or3 8N 152 t 15 t Auto 8.5 Incuded 2 or 3 E t 52 230 t ! - - -- Non 4.3 t 2 or 3 BE t 52 230 1 _ Auto 4.3 Included 2 or 3 Nt53 tt5 1 Non 10.5 1 2or3 BN t 53 t t 5 t Auto 10 5 Incuded 2 3 MODEL 152 i53 j ~ Feet Meters Goi. Liters Gol - j !tiers 'i 5 7.5 69 261 77 ' 29 i 10 3.1 61 I. 231 j 7G I 265 15 4.6 53 201 61 ~ 231 20 6.1 44 I 167 52 ! 97 25 7.6 34 r t 29 42 ' ~9 30 9.1 23 87 .3 '~~ 35 10.7 -- ' -- - 22 - b5 i 40 12.2 -- , -- - ~~ Lock Volve: 38.0 FL (1' 6m; tc0 c', "?_tr"; 3 21 _~ _~ I ;~j ,~ ,i~ I I .~_-_ I -~ sKZa~ - or SELECTION GUIDE E 153 230 1 Non 5.3 1 2 or 3 BE t53 23o t Auto 5.3 Ir~luded 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. O CAUTION 2. See FMOlt2 for correct model of ElectriCa! Alternator E-Pak. All installation of controls, protection dwices and wiring should be done by a gwlifled 3. Variable level Control switch 10-0225 used as a control activator, specify duplex (3) 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). or (4) float System. (~ c! Q` RESERVE POWERED DESIGN ~~ For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL T0: P.O. BOX 16347 ° Louisville, KY 40256.0347 Manulaclurers of . SHIP T0: 3649 Cane Run Road /7 qp ~ Louisville, KY 40211.1961 QU,dI/TY PUMPS SNCE ~~~/~/ ~ http://www.zoeller.com /~~MP ~0 (5021 118-2 73 1. 1(800) 928•PUMP FAX (50?) 774.3624 © Copyright 2000 Zoeller Co. All rights reserved. ` 0 80 160 240 320 FLOW PER MINUTE f-.- e , ; < -... ,. System Management Management of this system is critical. As a condition of approval of these plans this system management section must be reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber, Halverson Bros., 715-235- 0651, or the St. Croix County Zoning Office, 715-386-4680, should be contacted for assistance. General Proper functioning of an on-site disposal system, septic system, ' is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a dose tank or compartment to allow a dose to be accumulated, a pump and controls or automatic siphon, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. I . If the septic tank is installed prior to sheet-rock and/or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. 2. Install water-saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. 4. Never pour grease or oil down any drain or stool. 5. Garbage disposals are not recommended; if you must have one, use it sparingly 6. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. 9. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans. 10. If septic or dose tanks are no longer used, they must be properly abandoned. 11. If construction timing and weather could create a frozen infiltration system, weather-proofing with plastic sheeting and heavy mulching may be required to maintain a functional system at start-up. 12. If possible, the upslope toe of the mound system should be landscaped with additional fill to blend this area into the upslope natural grade; this will minimize the possibility of the system trapping surface run-off; final settled slope should be 2-3% over the system or 2-3% diverting surface run-off around the ends of the system. Maintenance 1. The septic tank must be inspected every three years by a properly licensed person. 2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. 3. When the septic tank is pumped, any solids in the bottom of the dose tank must be pumped, and the filter must be back-washed into the septic tank to remove accumulated material. System use may require more frequent filter cleaning; initial inspections of the filter should be made every 6 months until a minimum time sequence is determined. 4. Periodic observation pipe inspections should be made by the owner to examine the state of the in-situ soil adsorption cell. Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. 5. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. 7. Avoid compaction such as vehicle traffic within 15' down-slope of the adsorption system. 8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run-off into the system area. 11. Warning: Do not enter septic, dose or other treatment tanks; death may result because they may contain lethal gases or insufficient oxygen. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing, and/or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 ~ ~~~~~~ #2269 ~~~~~~`~"~~ ~~~~~~~~'` $ IL EVALUATION REPORT Pa e 1 of 3 Department Of erCe in a cordance with Comm 85, Wis. Adm. Code g r,,.,,~,,,., s c.,~ n„i~N~nno ~ n .,.,.,~. Certified Soil Testing, LLC ..,.,..,.,,. ,,..,~ ., ~ ....4r1'7~ -~ G LUUO County Attach complete si o pp not less than 8%: x 1 inches in size. Plan must '~ St. Croix include, but not limit 6iQldfli~lkefer ce point (BM), direction and to:~ ' Parcel LD percent slope, scale J~[g~~opr, and I ation and distance to nearest road. ditn~n . 004-1070 0- 00 Plea print all in orma -on. ~ Reviewed By Date Personal information you Lsed for secondary purposes (Privacy Law, s. 15.04 (1) (m)). provi ay Property Owner Property Location King, Rex Govt. Lot SE1/4, SE /4, S29, T28N, R15W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 120 290th St. City State Zip Code Phone Number ~ City ~ Village ®Town Nearest Road Spring Valley WI 54767 715-772-3232 Cady 290Th St. New Construction use: ®Residential /Number of bedrooms 3 Code derived design flow rate 450 GPD `~ Replacement ^ Public or commercial -Describe: -~. Parent material loess over till Flood plain elevation, if applicable NA ft. General comments install 4' x 112.5' rock cell mound on 100.0 contour as upslope edge of rock wi/ 1. 'sand fill and recommendations: `~ ^'~ Boring # ~ Boring Pit Ground surface elev. 99.4 ft. Depth to limiting factor 32 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPD/ft~ tn. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. `EffaY1 'Eff#2 1 ~ 0-10 lOYR 3/2 - sil 2 f sbk mvfr cs im .6 .8 2 10-32 lOYR 4/4 - sil 3 m sbk mvfr cs lm .6 .8 3 32-42 10YR 4/4 cap 7.SYR 5/8 lOYR 6 2 scl 0 m mfr - - 0 ~ 0 I I vertical 7.5YR 5/8,5/3 redox feature @ 28-32" w/ dark center of decayed root 2 ~'~, Boring Boring # '-- / Pit Ground surface elev. 100.0 ft. Depth to limiting factor 26 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPDlft' in: Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 1 0-13 lOYR 3/2 - sil 2 f sbk mvfr cs lm .6 .8 2 13-20 lOYR 3/3 - sil 1 m sbk mvfr cw lm .4 ~ .6 3 20-24 lOYR 4/4 - sil 1 m sbk mvfr cs lm .4 .6 4 24-26 10YR 4/4 - sil 1 m sbk mvfr cw 1m .4 .6 5 26-34 10YR 4/4 c2d0Y5YR 4/4 sil 0 m mvfr - 1m 0 .2 H 4 has 5YR 4/6 fs inclusions; NE pit corner has 5YR 4/6 fs @ 26-34" w/ cap lOYR 6/2 fs Effluent #1 = BODS> 30 < 220 mg/L and TSS 30 < 150 m /L 'Effluent #2 = B < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sign ur CST Number Henry F. Grote 222774 Address Certified Soil Testing, LLC Date Evaluation Conducted Telephone Number E. 4366 353rd Ave. Menomonie, WI 54751 11/5/2004 715-233-0398 SBD-8330 (R-07/00) Property Owner King, Rex _ ParcellD # 004-1070-50-000 i Page 2 of 3 _ 3 'Boring Boring # Pit Ground surface elev. 100.0 ft. Depth to limiting factor 24 in. 'x Soil Application Rat Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlft' in. Munsell Qu. Sz. Cont. CoIQ Gr. Sz. Sh. 'EN#1 'Eff#2 1 ~ 0-10 lOYR 3/2 - sil 2 f sbk mvfr cs lm 6 8 2 10-16 lOYR 4/4 - sl 2 f sbk mvfr gs 1m .6 ! 1.0 3 ~ 16-28 lOYR 4/4 - sil 2 f sbk mvfr cw if .6 .8 4 28-30 lOYR 5/6 c2d lOYR 6/2 fs 0 sg ml gw if .5 ~! 1.0 ' 5 30-38 lOYR 6/6,7/3 - fs 0 sg ml - - !, 1.0 .5 ---- - - North pit wall has f2d 7.SYR 4/6,5/3 redox features 24-28" ' Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BODS < 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) Certified SOiI Testing, LLC OO4-~~~~-.So-ooh ~2>c ``;~ - 1 \o'f" 1 ~c~~ 1~/ ~ ~~\~ y J G a.~ ~ ' ~ ~ l7` ~ v a'1. ~c~ `. ~ 1S ~~ G-~-~ zZZ~-~~ `C~'o ~. ~ ,, C..Q as ~~, S~. b~2 0~ ~~..~ s~s~~e 1 ~ ~ ~ ~ ~ ~ 4M-~. ~ .eX Ems, ~1~. ~ p d~ ~ Z~ a S i ~C AZ~'~, X50 ~.~..~~~ ai, g ~~` ___. l~ 121 ~.,, (~a~ ~~q.b> ?.o ~n( { ~-3 ~ ~ ~M ~~~:o~ ~~ e,~-5 ~_ r3.S 7b ~qa .4-~ ~ ~ i~ ~ / 3.0~ b /~ ~. (~ ~,zj 3 0~3 ~ - ~(aa.,~ / Z •s °~6 t------- CS ~ a 3~ b (~ a°,~,~ ~~~ ~~ ~oa~'' t~~e. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION Owner G Permit # I DESIGN PARAMETERS Number of Bedrooms ~ ^ NA Number of Public Facility Units ,~ NA Estimated flow (average) ~ al/da Design flow (peak-, (Estimated x 1.5) ~ al/day Soil Application Rate r ~") al/day/ftZ Standard Influent/Effluent Quality Monthly average" Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODb- 5220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODS) 530 mg/L Total Suspended Solids (TSS) 530 mg/L ^ NA Fecal Coliform (geometric mean) _<10° cfu/100m1 Maximum Effluent Particle Size Y8 in dia. ^ NA Other: ^ NA *Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity ~'3~ gal ^ NA Septic Tank Manufacturer ~/~~~~~ ^ NA Effluent Filter Manufacturer ^ NA ~ Effluent Filter Model p~ ^ NA Pump Tank Capacity ~S"~ al ^ NA Pump Tank Manufacturer ^ NA Pump. Manufacturer ,~ ^ NA Pump Model S~ ^ NA Pretreatment Unit ^ NA ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Dispersal Cell(s) ^ NA ^ In-Ground (gravity) ^ In-Ground (pressurized) ^ At-Grade f~ Mound ^ Drip-Line ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 ^ monthls) (Maximum 3 years) ~ earls) ^ NA Pump out contents of tank(s) When combined sludge and scum equals one-third IY31 of tank volume ^ NA Inspect dispersal cell(s) At least once eve ry' ^ month(s) ~ yearls) (Maximum 3 years) ^ NA Clean effluent filter At least once every: ^ month(s) ~ year(s) ^ NA Ins ect um p p p p, pum controls & alarm At least once every: 3 ^ month(s) ~ year(s) ^ NA Flush laterals and pressure test At least once every: ~- ~+ ^ month(s) .~ yearls) ^ NA Other: At least once every: ^monthls) ^ year(s) ^ NA other: ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third IY3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting. product's 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 shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal ceII1s) 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~fevels 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, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ^ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems 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 s 4 POWTS INSTALLER Name ~ w~r~'l Phone ~/S- - a`j ~ - ~6'S~ ~ POWTS MAINTAINER Name Phone ~ r~ SEPTAGE SERVI ING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phon ~~ / Name -~ ~ ~~ Phone ~' 3 This document was drafted in compliance with chapter Comm 83.22121(b111)Id)&If) and 83.54(11, (2) & 131, Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address Property Address QX ~cc~. ~~~ S~ ~ ~~ v i h. s ~~ 1 S~~~s (Verification required from Planning & Zoning Department for new construction) City/State CAc~ ~ ~ 1n! ~ Parcel Identification Number ~ d ~; ~ ~ (~ d '" s (~ ~ v Ov `~(oS"~ LEGAL DESCRIPTION Property Location S~ '/4 , ~~ '/4 ,Sec. , T a~ N R /~_W, Town of ~~ ___ Subdivision Certified Survey Map # Lot # Volume ,Page # Warranty Deed # ~ ~ ~ ~ ~ ~ ,Volume ~ ~ S ~ Page # Spec house yes no Lot lines identifiable 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 Departr~ent 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. Uwe, the undersigned have read the above requirements and agree to maintain the private ewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of,TTa,$~spurces, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned. to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms ~~13i6~ SIGN TUBE OF APP ICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) DOCUMENT NO. y~l^ 145SPAG~ 147 QUIT CLAIM DEED /o tE's 102.86 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CkOIX CO., WI RECEIVED FOR RECORD 09-1-1999 9:30 fIM IT G SIN DEED E~ ~ ~ HOLLY L. KING, Grantor, quit claims to REX M. KING, Grantee, CERT COPY FEE: COPY FEE: TRRNSFER FEE: the following described real estate in St. Croix County, State of Wisconsin: RECORDING FEE: 10.00 PaGES. I U C Parcel No^4-1070-5~Q~O ~jIM3CL1, s...N~l-$ Tt~: 7/ RE ~ ~ ~ ii1c & Ahsetaet C,c~rr.~ary age `I Vill 2550 University A~~P,rtt:e Vvt;sl. Suite 214 Ne12h S~9 o vi ~ 5 3 fi1~ ss t l~ The Southeast Quarter of the Southeast Quarter (SE I/4 SE 1/4) of Section Twenty-nine (29), Township Twenty- eight (28) North, Range Fifteen (15) West. THIS DEED GIVEN PURSUANT TO THE TERMS OF A JUDGMENT OF DIVORCE GRANTED BETWEEN THE ABOVE PARTIES IN THE CIRCUIT COURT FOR ST. CROIX COUNTY, WISCONSIN ON THE 19TH DAY OF JULY, 1999. This is homestead property. Dated this~~--day of August, 1999. ~~~'T~~iX~~l.~ ~ ~4~~Uic--~i~' SEAL) Holly L. King AUTHENTICATION Signature o: Anastasia Asp authenticated this _ day of Augu>t, 1999. TITLE: MEMBER STATE BAR OF WISCONSIN If not, authorized by § 706.06, Wis. Stets. TEtI3 INSTRUMENT DRAETIiD BY: ACKNOWLEDGMENT STATE OF WISCONSIN } SS ST. CROIX COUNTY Personally carne before me this~~~dey of August, 1999, the above named Holly L. King, to me known to be the persons who executed the foregoing instmment and acknowledged the same. Robett W. Mudge, Attorney . MUDGE, PORTER, LUNDEEN & SEGUIN, S.C. /] / 1 10 Second Street, P.O. Box 469 y (~~ /~~ G~~ O 4 Hudson, Wisconsin 54016 Notary Public, State Wisconsin - {Signatures may be authenticated or acknowledged. Both are not necessary) My Commission: =1 _ 1 ~ . SOU ( rn,swore..~..;gn;~;.a,ra.p.~ty.naaa~ervw o. n•~~«a eaow,ne;r aaa.wr... ~.. ~Klmberly A. RACNartlee QUIT CLALYI DEED NOtary PUbIIC ~_ ,~ State of Wlsconsln ArcIMS Viewer Page 1 of 1 http://72.21.230.178/website/LRPortaVARCIMS/MapFrame.asp?PIN= 1117!2005 ArcIMS Viewer Page 1 of 1 http://72.21.230.178/website/LRPortaUARCIMS/MapFrame.asp?PIN= 11/7/2005 Oct 31 04 Q7:30p RHC SEPTIC 7156652112 10/29/04 FRI OB:D1 FAJ[ 715 atltl 4tlDtl sl' LNd 1:u cuNtrv~ ~ ~~~ Dni~~ 7162 zoo w_ ~ld~iaep~ ~- r,A. saa ;cousin , ~;;s; 7t62 meet of Commerce Sanitary Permit Applicstion is ~~ r,.e Rt'~: ~`a~ ~ sue' ~ 1(~1~ {. wPelieati~a rararw.+... ^- a""" ST GIt a i s. y w~>Mrsa: ~° ~ ~ s,as n,. • 2D ~~9~' ~in~n~ ~~ ~E~ sue. T?$.~ a r5~~.~ 0, HuYdia~ (c1~eNc all t •r~PFb9 ~ a~.,.P--.._.~ ar 1 Wai~Y prdllae'lbebe<d~ OlrttidGw°tir-tlesa$eV'c Ocar O~'~ow~ fa S~eoawd-O~~ fI1. ~e~ Yf ~ K'11lic'k aab ~ y rl/t ~ d~ M~diGv ~' O Ner. s~v. O R0~°iA°` ~°'" L71Yf _ ,~. r.rn sT ~rkw ~ .. O~e:.~t d e~a.~x~.~ oW.. e.to~~~ ~ roa-ra Ciadc au • sal D ~~ O sldc ram s~ ra•~ D t,w~eu.a O rf~.d :u i...r.i~k ~ O t+to^d ~u ti-.ra:oae Olme+aa+as ~ 1AUrr O O~-r+a.~~ Ore~ra~r ^w~u~c~ ~ Na1rn0 Q !KS„nsd yrikw,.d O fi~1d'K~ _ _ ~_ n iL ~ '-Pipe ~ OQror (oeVbl f] eoow.aa ~ D o..~ovice ~~ ~P G(//~~ ~~e~,~~~1~ aF E,i'~s~, o ~~~~~~.J owJ ~o~z8~o`/• ~v~ GJF~ i `~DIiC tanK. effluent 61ter and dispersal cell must all be soryited ~ maintained as per managoment plan provided by piumber• 2. All setback requ'aemente must be maintained ee per applicable Cotse/prdinances. SBD-639f3 (iz. OL/0 {-ee~rJ A T' I ~ VYlS C:~~ ~~~ ~ / ~. ~':S"~~'~-- G S't. Croix County Zoning Wednesday, November 24, 2004 at 3: SD:OI PM Detail Sanitary Information Page 1 of I Computer #: 004-1070-50-000 SublPlat: 40 acres Section: 29 Parcel #; 29.28.15.465 Lot: TN/RNG: T28N R15W Municipality: Cady Township CSM: 1/4 1/4: SE 1/4 SE 1/4 Owner: King, Rex M. 120 290th Street Spring Valley, WI 54767 State Permit: Issued: POWTS Dispersal: NA Permit: Replacement of Tank County Permit: 0 Installed: 11/03/2004 POWTS Detail: NA Bedrooms: 4 WI Fund: POWTS Pretreatment: Unknown Notes Inspector As Bui-t Plumber er Requirements ~ Additional Notes Money Owed Pam Quinn NA Mittlestadt, Tim Original application with fees and plans for Received an emergency call that a tank had been $350.00 replacement system that will be a mound damaged during basement waterproofing and Signed Off: No .-_-~ according to plumber needed immediate replacement. Mark Iverson -~----- inspected tank(Huffcutt 1250/750 combo) and obtained measurements to be added to future replacement system - no fees were paid yet. 201 W. Washington Ave., P.O. Box 7162 1 I S~~~Sj~ Madison. WI 53707 - 7162 (608) 266-31 S I Oe artment of Commerce Sanitary Permit Application In accord with Comm 8321, Wis. Adm. Code, personal infom-ation you Provide may be asst for sewrdary Purposes Privacy Law, sI 5.04(1 xm) Application Information -Please Ptiat All Iafotznation City, SIatC ~ / up a.wc ~ ~j. lypt'oI 1in1101[Ig ~CRe¢n au anaawt.t+y/ 1,.(J,'I o%r 2 Family Dwelling - Number of Bedrooms ^ pablic/Commacial -Describe Use ^ state Owned- tkxcribe Use III. Type of Permit: (Check Daly one box on line A. Complete line B if applicable) A' ^ New System ^ Replacett-ent System ~Ttaumen t Only B. ^ Pamir Ratewal ^ Pamir Revision ^ Ctautge of ^ Pexmit Transfer to New Before Expiration Plumbs Owner r Permit Number (to be fit rn by Co.) Ian I.D. Numbs Address (i~ u~ptt titan mailing adder Property Location ~i/,~ S ~ { T S~ Y., / '/., Section _~_ ^ ~fCle T~N; R ~~ EorW I Subdivision Name i _ CSM Numbg ^City ^Village Modifiation to ~ RUIL a / ~r/ IV. 7 OT YU W 1J ~ em: a,accn au sues a ^ ^ Non -Pressurised in-Ground ^ Mound >_ 24 is of suitable soil ^ Mound < 24 in. of suitable sot ^ At-Grade ^ Singfe Pass Sand Filter ^ Constructed Wetland ^ Pressurised In-Ground ^ Holding Tank ^ Peat Filter ^ Aaobic TreaUna-t Unit ^ Rociralating Sand Filtex ^ Reeiratlating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (eurplain) V. D'u tsaVTreatment Area Information: 1 Area proposed (sfj System Eltvadon ..____ ~_...._...,. r,..:.,.. G:1 •,.nlirAfinn Rnt~ondsfl Dispersal Area Required (sf) Disperse VI. Tank Info Gallons I ofUnits Concrete ~ Constnxted ~ ~ Glass Uf=, VII. Responsibility Statement- >4 the aaderaigned, assame respoesibilt for lastallatioa of the POWYS shown oa the attacked plaits. Plumber's Si ro MP/MPILS Numbs Business Phone Number Plumber's Name (Print) ~m ~m i~.~~-sue /- 7is- t~5'-~ I ~/~ Plumber's Address (Strcet, City, State, Zip Code) /n 00% /e 5~b ~~fS~ 7 2~ 2 ~Sf ~ ~ DU,Z s 7 VIII. Coun •/De art ent Use Onl ^ Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps Surcharge Fce) ^ Owner Given Reason for Denial n_,,,, IX. oSnditions of A t troval/Itwsans for Disapproval ~//ST/ ~/~ ~~~ ~(/~S. fDff~(," ~~ 1 eptic tank, effluent filter and ,~~i~/~~ (,{/~{ -~ 7°i~0v~//`~u(` ~~ c~! /`s,~/ dispersal cell must all be serviced /maintained J / !I ~,~~ d~ lD 2~ D 7 ~ /~/ as per management plan provided by plumber. ~-10~5~ 7" U (~~ ~~/ / / / 2. All setback requirements must be maintained ~~~~~ QLJJ ~-/J,~ as per applicable code/ordinances. ~ ~t!~'~lfG~r;., ~ ~ Q ~ . ~ -~ ~ Attoch eompkte p4m (to the Coaaty )for the system ea pa sot ~hsa it ~ 1 ioe~_ tgr~T~~ /~ ~j. ~r SBD-6398 (R. 01/03) ~US77~Cr w eGll /a'~- U fi-~~~ ~ ~-- ~Ef L~ G~~ ~ ~ ~- ~/la~.E- ~~ ~ ~ s ~ ~ Pam Quinn ph (i(f ~-~'o ~ Subject: Midd ~~, Location: '' . ,. Start: Wed 11/3/2004 SQE~AM End: Wed 11%2'004 8:30 AM Recurrence: (none); ~. Tim Middles~eadt~had to~r:eplace a tank on Saturday with our permission due to damage to original tank. He faxed us a signed application and will be following up with money and paperwork. We just need the elevations and focat"rrir9 aif Mevu tank docuKneCtted~;j~eas~"' '' I ~Q. 1 i-3-v ~a ~o ~.e -~-~`I" Est Ip ~{.., ~o~ ~ L G ~ `a G y. u ~~,~} i 2'S v J r 7 Sv U ~~~ t ~ 5v' s ; f G ~ ~asN- ~~~ w~ ~ `~ _ 0 ~ r~- j~ ~ ,f ~~ Y Owner/ Mailing Address ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM /2v Z 9D ~ sue. S~'i~/,~/~ I/~ Property Address -S~~C.Q~ ~ ~,rO (Verification required from Planning Department for new construction.) City/State Parcel Ide:~tification Number Qy ~ - /Q ~ Q - -~- ~~~ LEGAL DESCRIPTION ~~{~S~ Property Location SE % , S~ '/. ,Sec. 2 ~ , '1' 2~ N R W, Town of ~~~ Subdivision Certified Sur~v+e~y, Map # ,Volume - ,Page # Cam/ W my Deed ~~~ ~ ~(~ ~ ~~o _ ,Volume 1 ~ 5 b / ~ ~ge #, Spec house yes no Lot lines identifiable yes no Lot # ~~ ;~~ t SYSTEM MAINTENANCE Impro er use and maintenance o`~e ti s stem could result in its rematur~ to han wastes. Proper~~ P Y P Y P 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 ? 2 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County 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. Uwe, 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 end 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 Department within 30 days of the three year expiration date. ~/ i2 / G SIGNATURE OF APPL DATE OWNER CERTIFICATION Uwe 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 ab , by virtue of a ty deed recorded in Register of Deeds Office /r ~/ ~7 / ` `C SIGNA OF APPLICANT DATE ****** Any information that is misrepresented 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 and a copy of the certified survey map if reference is made in the warranty deed. ~~. ~~ To:~, ST. CROIX COUNTY WISCONSIN ZONING OEPAItTMENT ST. CROUC COUNTY GOVERNMENT CENTER 1101 Camtid~ael Road Hudson. WI '~- Pf~one: (Tt Fax (715)38G~1686 • From: ~ ~. Fauc ~~ ~ - ~ ~ ~ - ~ (( ~~ Payex Z ~ C~4~~ p SSA - ~S(v ~ Date: 102 ~ ot/ Re: ~i~ ^ For Review ~ Please Comment 10~P[ease Reply ^ Please Recycle ~~~- ~~ ~ ~~~~ 6L~in vim, ,~~~'n G iM.2 w^'!x_ n ~~~~J'~~q~ ~/ y /v~~ On, i~~FrnR '// X S/ ~~,~ ~~ ~~ a~ v~,~~ ~,,~~ ~,~ ~~~~ ~~, ~~~ ~v"~, ~ ~~ ~ ~ ~~G~iz~- ~s~~ .i''` DOCUMENT NO. vnr:~.1456PAGC 147 QUIT CLAIM DEED (D ~zo~~~ KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 09-f~-1999 9130 AM EO%EIMPT AIM DEED ~ HOLLY L. KING, Grantor, quit claims to REX M. KING, Grarttee, CERT COPY FEES COPY FEE: TRIIWSFER FEES RECORDIti6 FEE: 10.00 the following described real estate in St. Croix County, State of Wisconsin: PRGES: 1 U p Parcel No^4-1 70_ RE Vti a~~gc ttlc & Ahslcact L;,crr.TsartY 2550 University Avrtit;e Vliust. Suite 214 North S niPrtul, MirrtP~l3 SSL t4 ~~ o r85S The Southeast Quarter of the Southeast Quarter (SE 1/4 SE 1/4) of Section Twenty-nine (29), Township Twenty- eight (28) North, Range Fifteen (15) West. THIS DEED GIVEN PURSUANT TO THE TERMS OF A JUDGMENT OF DIVORCE GRANTED BETWEEN THE ABOVE PARTIES IN THE CIRCUIT COURT FOR ST. CROIX COUNTY, WISCONSIN ON THE 19TH DAY OF JULY, 1999. This is homestead property. Dated thisQ~~)'"'day of August, 1999. G~~-~ ~C - /~~~~ (SEAL) Holly L. King f/ AUTHENTICATION Signature of Anastasia Asp authenticated this _ day of August, 1999. TITLE: MEMBER STATE BAR OF WISCONSIN IC not, authorized by $ 706.06, Wis. Stets. THIS INSTRUMENT DRAFTED BY: Robert W. Mudge, Attorney MUDGE, PORTER, LUNDEEN 8c SEGUIN, S.C. 1 10 Second Street, P.O. Box 469 Hudson, Wisconsin 54016 {Signatures may be authenticated or acknowledged. Both are not necessary) ACKNOWLEDGMENT STATE OF WISCONSIN ) SS ST. CROIX COUNTY Personally came before the this~~ of August, 1999, the above named Holly L. King, to me known to be the persons who executed the foregoing instrument and acknowledged the same. Notary Public. State al' Wisconsin My Commission: =1 ' 1 lp ~tOU •N>m«era..~.,:~~c.a~~r~+w~+a•h~d~~rv.ao.v~ntaeneioWrna..+s~~,~•. ~_ ~1Cimberly A. MCMan788 QUIT CLAIM DEED ~ Notary Publlti _ w Stets of Wlsconsln Parcel #: 004-1070-50-000 10/29/2004 08:34 AM PAGE10F1 Alt. Parcel #: 29.28.15.465 004 - TOWN OF CADY Current ^X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): * =Current Owner * KING, REX M REX M KING 120 290TH ST SPRING VALLEY WI 54767 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description * 120 290TH ST SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH gal Description: Acres: .000 Plat: N/A-NOT AVAILABLE EC 29 T28N R15W 40A SE SE EZ-U-1466/212 Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 29-28N-15W Notes: Parcel History: Date Doc # Vol/Page Type 09/14/1999 610286 1456/147 QC 07/23/1997 1123/500 W D 2004 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 05/25/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 28.000 2,800 0 2,800 NO UNDEVELOPED G5 1.000 100 0 100 NO PRODUCTIVE FORST LANC G6 9.000 6,300 0 6,300 NO OTHER G7 2.000 6,000 70,700 76,700 NO Totals for 2004: General Property 40.000 15,200 70,700 85,900 Woodland 0.000 0 0 Totals for 2003: General Property 40.000 15,600 70,700 86,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/1712001 Batch #: 511 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: U04-'I 07U-ZU-~UU 10/29/2004 08:35 AM PAGE 1 OF 1 Alt. Parcel #: 29.28.15.462 004 -TOWN OF CADY Current ^X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): * =Current Owner * KING, REX M REX M KING 120 290TH ST 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: 40.000 Plat: N/A-NOT AVAILABLE SEC 29 T28N R15W 40A NE SE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 29-28N-15W Notes: Parcel History: Date Doc # Vol/Page Type 11 /05/2003 745862 2450/509 LC 03/16/2000 619695 1495/605 QC 07/20/1998 583265 1341/344 QC 07/23/1997 1125/280 LC 7nnA c~ InnnneQV Bill #: Fair Market Value: Assessed with: -- - - - - ------- -- - Use Value Assessment Valuations: Last Changed: 05/25/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 36.000 3,000 0 3,000 NO UNDEVELOPED G5 1.000 100 0 100 NO MANAGED FOREST LAND-C W8 3.000 2,100 0 2,100 NO Totals for 2004: General Property 37.000 3,100 0 3,100 Woodland 3.000 2,100 2,100 Totals for 2003: General Property 37.000 3,400 0 3,400 Woodland 3.000 2,100 2,100 Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch #: PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 004-1070-30-000 10/29/2004 08:35 AM PAGE 1 OF 1 Alt. Parcel #: 29.28.15.463 004 -TOWN OF CADY Current ^X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): " =Current Owner * KING, REX M REX M KING 120 290TH ST 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: 40.000 Plat: N/A-NOT AVAILABLE SEC 29 T28N R15W 40A NW SE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 29-28N-15W Notes: Parcel History: Date Doc # Vol/Page Type 11 /05/2003 745862 2450/509 LC 03/16/2000 619695 1495/605 QC 07/20/1998 583265 1341/344 QC 07/23/1997 1125/280 LC 2004 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 04/14/2003 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 5.000 600 0 600 NO MANAGED FOREST LAND-( W8 35.000 24,500 0 24,500 NO Totals for 2004: General Property 5.000 600 0 600 Woodland 35.000 24,500 24,500 Totals for 2003: General Property 5.000 600 0 600 Woodland 35.000 24,500 24,500 Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch #: PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00