HomeMy WebLinkAbout032-2172-03-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division Sanitary Permit No:
INSPECTION REPORT 556317 0
GENERAL INFORMATION. (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Signature Bank Somerset, Town of 032-2172-03-000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 41- / 18.30.19.1443
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTU R CAPACITY STATION BS HI FS ELEV.
- 9S ,
Septic Benchmark
/,76 /o1.7 1490
Alt. BM OI . p 7
Frt ~a Ia 525 ~=,~~.~G~~ "1 I
Aeration Bldg. Sewer
f2 !2r-
Holding, St/Ht Inlet
AffW /61,7Z St/Ht Outlet
TANK SETBACK INFORMATION 9 $
TANK TO PP/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Li t~
Dt Bottom
o
7O'
Dosing Header/Man. q
- /b. Z I Aeration Dist. Pipe /D -W / • Z Z
l.7 4'.97
Holding Bot. System /1. 2-
/Z .7
PUMP/SIPHON INFORMATION Final Grade 1A1 7
Manufacturer Demand St Cover q
GPM /
Model Nu er
TDH Lift Friction Loss System H 11H Ft
Forcemain Leng _ Dist. to well T- -
SOIL ABSORPTION SYSTEM
BED/TRENCH Width LNo. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. id Depth
DIMENSIONS 3
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: E/D~
INFORMATION CHAMBER OR
Type Of System:I 220 ' g~~ I UNIT Model Number:
DISTRIBUTION SYSTEM laesh 4-1 Header/Manifold ( f Distribution Ix Hole Size x Hole Spacing Vent to Air Intake,
Length COI Dia ( Pipe(s)
Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Ve ea
Depth Over Depth Over xx Depth of xx Seeded/Sodded Mulched
Bed/Trench Center 7,S Bed/Trench Edges I-, Topsoil Yes 0 No T Yes 0 No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: / /
Location: 342 153rd Ave Somerset, WI 54025 (NW 1/4 SE 1/4 18 T30N R19W) St. Croix National Southern Estates Lot Parcel No: 18.30.19.1443
1.) Alt BM Description
2.) Bldg sewer length =
- amount of cover =
Plan revision Required? FA-1 Yes No 7S
9
Use other side for additional information.
Date Insepctor's Si ature Cert. No.
SBD-6710 (R.3/97)
PLOT PLAN N
Project Name: Fieldstone Family Homes Inc.
Legal Description: NW1/4, SE1/4, S18 T30N, R19W P.I.D: 032-2172-03-000
Subdivision Name: ST. CROIX NATIONAL SOUTHERN EST. Lot M 3 SCALE: I" = 50'
Township: SOMERSET Parcel Size: 3.0 Acres
County: ST. CROIX
System Elevation: T1=90.20' Proposed 90' EZ Flow Trench
Slope: 11% T2=89.00' Proposed 90' EZ Flow Trench
A BM1 Elevation: 100.00' To of 3/4" PVC Pipe
~ BM2 Elevation: 99.80' To of 3/4" PVC Pipe 4 inch Sch 40 -ASTM D2665
M Backhoe Pits: 4 inch 3034 - ASTM D3034
Geotextile fabrics to meet requirementsof Table
TANK SCHEDULE 384.30-12
1 Proposed 1250 gallon septic tank w/Pol lok 525
NOTE: See page 11 for a more complete lot of the parcel.
LI "
C/4~~f~c
I L? v C ;c 02
~ 7 ~JC ~ ~1 + A
.ll. d I-
~ i
9 14
v
Ni 23
Goo f :x ~
Page 2
County
`x
RECEIVED Safety and Buildings Division 5-z
201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.)
° p Madison, WI 53707-7162
e%
AUG 2 3 701Z J~5(p 3
S1 ~ V&rnit Application State Tr a on Number
pLANNI"'
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit /V ft'
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address)
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law, s. 15.04 1 m , Slats. / (J~
1. Application Information - Pleas Print All In rmatio
Property Owner's Name l r1 Qy w Parcel #
032--Zi 7z- 03-000
Property Owner's Mailing Address S~ I G Property Location 3 j 6
73
Govt. Lo ~I
l~ E 1 /"t r f~L I d ~L
City, State Zip Code~~ Phone Number A10y, 5e y., Section
ircle one
LA CV/ LL- J56 T Y0 N; R < / EoiW
H. Type of Building (check all that apply) Lot #
od I or 2 Family Dwelling - Number of Bedrooms r%41) Subdivision Name S 71 C- Ole V 1 x
64 Gid Block /V A:rk,,V AC 5047-14,ee 5/.
❑ Public/Commercial - Describe Use ❑ City of
❑ State Owned - Describe Use CSM Number ❑ Village of
L gym- GU t.✓ ! f" / -VIa QJT~ e-.~, iaTownof St7i1'IEi~S~`'T
III. Type of Permit: (Check onl one box on line A. Complete line B if applicable)
A. 9.New System El Replacement System El Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain)
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Owner • E
IV. T e of POWTS S stem/Com onent/Device: Check all that apply)
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)
V. Dis ersal/I reat ent Area Information:
Design Flow( d) Design Soil Application Rate pdsf) Dispersal Area Required (s Dis rsaI Area Proposed (sf) System Elevation
to t?C7
0th -61D
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units II' c, U
Existing Tanks o
New Tanks L
Septic or Holding Tank ! 7 t~ o 12-60 / / (e
Dosing Chamber L F-+71 I
VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's MP/MPRS Number Business Phone Number
ZZ 371,rZ) 1715--769- c~VP
Plumber's Address (Street, City, State, Zip Code) w _
r'N
VI oun /De artment Use Only 17
app Permit Fee Date issued
Approved Issuin gent Signature
11 n Reason for Denial 5 ',Z3 //Z
Ix. Conditi gf1, easons for Disapproval
A: 'Septic tank, effluent filter and
dispersal cell must all be services / maintained
ft per management plan provided by plumber,
2. Apstet R regttreme(1ts must.be mainWred
as ' 'dock / orttinfrioea
Attach to complete plans for the system and submit to the County only on paper not less than 81a x 11 inches in size
SBD-6398 (R. 11/11)
4 CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: St. Croix National Southern Estates Lot 3
Owners Name: Fieldstone Family Homes
Owner's Address 17645 Juniper Path Suite 135
Lakeville, MN 55044
Legal Description: NW1/4, SE1/4, S18, T30N, R19W
Township Somerset
County: St. Croix
Subdivision Name: St. Croix National Southern Estates
Lot Number: 3 Block Number
Parcel I.D. Number 032-2172-03-000
Plan Transaction No.
Page 1 Index and title
Page 2 Plot Plan
Page 3 System Sizing & Cross Section
Page 4 Septic Tank Specifications
Page 5 Effluent Filter Information
Page 6 & 7 Management and contingency plan
Page 8 Septic Tank Maintenance Agreement
Page 9 EZ Flow Information
Page 10 Warranty Deed
Page 11 Map
Page 12-14 Soil Evaluation Report
Designer: John Schmitt Licnese Number: MPRS 223760
Date: 8/22/2012 Phone Number: 715-760-0486
Signature: t'l'" Z"
In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01)
Page 1 of 14
PLOT PLAN N
Project Name: Fieldstone Family Homes Inc.
Legal Description: NW114, SE114, S18 T30N, R19W P.I.D: 032-2172-03-000
Subdivision Name: ST. CROIX NATIONAL SOUTHERN EST. Lot 3 SCALE: V a 50'
Township: SOMERSET Parcel Size: 3.0 Acres
County: ST. CROIX
System Elevation: T1=90.20' Proposed 90' EZ Flow Trench
Slope: 11% T2=89.00' Proposed 90' EZ Flow Trench
BM1 Elevation: 100.00' To of 3/4" PVC Pi
BM2 Elevation: 99.80' To of 314" PVC Pi 4 inch Sch 40 -ASTM D2665
Backhoe Pits: 4 inch 3034 - ASTM 03034
Geotextile fabrics to meet requirementsof Table
TANK SCHEDULE 384.30-12
1 Proposed 1250 gallon septic tank w/Pol Iok 525
NOTE: See page 11 for a more complete lot of the parcel.
I
LI gcc acO . G AL' Aim 2
IB~GSt v
r
V
V%
1
I 8ZU w
~y \ N
%U / r
jR3
rJ
0
B! r~3
Q3p
Page 2
.
SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT
Project Name: Fieldstone Family Homes Inc.
2 No. of Cells 9 Per Cell
3 ft Cell Width 18 Total No of 1203H
90 ft Cell Length 450 sq ft EISA Per Cell
3 ft Cell Spacing 900 sq ft Tota ISA
Manufacturer Model Laying Length EISA Rating
Infiltrator EZ1203H-5ft 5.0' 25.0
EZ1203H-10ft 10.0' 50.0
Gravelless Leaching Unit Manufacturer: to Infiltator
Gravelless Leaching Unit Model: 1203H
Typical Cross Section
Finished Grade 95 ft
Observation Pipe with
approved cap or vent
■
Soil Backfill
60 in
Geotextile Fabric ,
.
89 ft Infiltrative Surface
12 in I it
86.2 ft Limiting Factor
>36 in Slotted and Anchored Vent/
Observation Pipe with Cap
■ ■ ■ ■ ■
Plumber/Designer Signature:
License DE-1927-7 Date: 22-Aug-12
Page 3
a
z
X
m 52~ AS 84"
REQD
D
z
c 41"
a Z
0 m
nN
~ s
m
O
I
t L_
m UP 40" s
m
0 4" CAS \ 0
M D
" 5" I
D
m
o
N
~ r
~
X 3" L4"CAS
0 D
_n
r- 0
m
V
C
o v
M
m
rn
z cc 4-
39" F
m n
I
D
I
N
m
D
r
c DO D Z r0 =O Z Z
_n 0 -chI ~A X v v 5 F R Z Z
Ju rnD a Jz nc~ (7 pga 0 Pa ~ jmVzmy0c0DN ~
(70 XX ~z OP v ~ ~ a np (n0a OC0~0==r~f~rrZ
o ~
vci rrnC, 0rWrr > 4z 0 ~pzo mX C, >o ~ —zn,N
oa N~ \c Fa o Nc 4c oDRz~-crvs..
ZO =of m z aor 01 9 ODAR =NN m\ m IV
~N ~IIsaZ~ OD `Dg Dm W aN~ ND~ 0r~p0`" ~N n (J1
D z OOD ~a AIn 0_0 ~ Nmco I m W~0\N- A
_ s i -n > FD
< O O c U U/ rnZ \N A O ~ O mph Dr CA 'p~ V; n I
M m z W O p v C~ N ~ro*r D m>rr*1 m0
v m z m 0W r o a K) =ra rp c m
yy 0
< o
-0 z m H A ;Vv O Z 00 Z
Z V D O D D v0-j o~
T m r c z 0 -4 --I m 0 W
O m 21 v_~ c c o o rM* 00 (A -0 0 z z
7v m x om Np N m> Z
-4 Z v ~ A r C rM*
H 0 o rD-M Fn
z - A ;u
m
F
\(n WLP1250-MR
m DRAWN BY. SME SCALE: 1/4'=I'-O' PRE-POUR:
° -mi SEPTIC MANUAL MHER C®ACBETE REV.
W3716 US HWY 10 MAIDEN ROCK, WI 54750 DATE: JANUARY 2010 DATE:. POST-POUR:
REVISED JAN. 2010 800-325-8456 FlLE: Von-W
Page 4
f
4
- s o Filters
PL-525 EFFLUENT FILTER (COMMERCIAL)
Polylok, Inc is pleased to add its
new commercial filter to its existing
line of quality effluent filters.The
PL-525 is rated for over 10,000 GPD Alarm Accepts PVC
(gallons per day) making it one of accessibility extension handle
the largest commercial filters in its
class. It has 525 linear feet of 1/16"
filtration slots. Like the Polylok
PL-122, the new Polylok PL-525 has
an automatic shut off ball installed 525 linear feet
with every filter. When the filter is of 1/16°
removed for cleaning, the ball will filtration slots Rated for over
float up and temporarily shut off 10,000 GPD
the system so the effluent won't
leave the tank. No other filter on
the market can make that claim! Accepts a° & V
SCHD. 40 Pipe
PL-525 Maintenance:
The PL-525 Effluent Filter should
operate efficiently for several years
under normal conditions before
requiring cleaning. It is recom-
mended that the filter be cleaned
every time the tank is pumped or
at least every three years. If the
installed filter contains an optional
alarm, the owner will be notified
by an alarm when the filter needs
servicing. Servicing should be Gas deflector
done by a certified septic tank Automatic shut-off
pumper or installer. ball when filter
1. Locate the outlet of the U.S. Patent No# 6,015,488 is removed
septic tank. 5,871,"0
2. Remove tank cover and pump
tank if necessary. PL-525 Installation: 1. Locate the outlet of the
3. Do not use plumbing when septic tank.
filter is removed. Ideal for residential and com- 2. Remove the tank cover and
4. Pull PL-525 out of the housing. mercial waste flows up to pump tank if necessary.
5. Hose off filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the
tank. Make sure all solids fall 4 or 6 outlet pipe. If the
filter is not centered under the
back into septic tank. access opening use a Polylok
6. Insert the filter cartridge back Extend & Lok or piece of pipe
into the housing making sure to center filter.
the filter is properly aligned and 4. Insert the PL-525 filter into
completely inserted. its housing.
7. Replace septic tank cover. 5. Replace the septic tank cover.
Page 5
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page-of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner: Fieldstone Family Homes Inc. Tank Manufacturer: Wieser Concrete F NA
Permit # E Septic E Dose Holding Volume: 1250 gal
DESIGN PARAMETERS Tank Manufacturer: Wieser Concrete A NA
Number of Bedrooms: 4 r NA E Septic E Dose Holding Volume: al
Number of Public Facility Units: F NA Vertical Distance Tank Bottom (s) to Service Pad: ft
Estimated (average) Flow: 400 gal/day Horizontal Distance Tank(s) to Serivice Pad: ft
Design (peak) Flow = estimated x 1.5: 600 gal/day Specific servicing mechanics must be provide if vertical is>15 feet or if
In Situ Soil Application Rate: 0.7 gal/day/ft2 horizontal is > 150 feet. Specific instructions to be provided on back.
Standard Domestic InfluentlEffluent Monthly average Effluent Filter Manufacturer: Polylok F NA
Fats, Oils & Grease (FOG) 5530 mg/L Effluent Filter Model: 525
Biochemical Oxygen Demand (BOD5) 5220mg/L r NA Pump Manufacturer: w NA
Total Suspended Solids (TSS) 5150mg/L Pump Model:
High Strength InfluentlEffluent Monthly average Petreatment Unit
Fats, Oils & Grease (FOG) 530 mg/L Manufacturer:
Biochemical Oxygen Demand (BOD5) :5220mg/L NA r Mechanical Aeration r Peat Fitter NA
Total Suspended Solids (TSS) 5150mg/L r Disinfection r Wetland
Petreated Effluent Monthly average r Sand/Gravel Fitter r Other.
Biochemical Oxygen Demand (BOD5) 530mg/L Soil Absorption System
Total Suspended Solids (TSS) 530mg/L NA 0 In-Ground (gravity) r In-Ground (pressure) r NA
Fecal Coliform (geometric mean) !5104cfu/100m1 r At-Grade r mound
Maximum Effluent Particle Size: Ye in dia. r N r Drip-Line r Other:
Other: Other: F NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
When combined with sludge and scum equals one-third of tank volume
Pump out contents of tank(s) When the high water alarm is activated
month(s)
Inspect condition of tank(s) At least once eve : 3 i year(s) (Maximum 3 ears) r NA
r month(s)
Inspect dispersal cell(s) At least once eve : 3 10 year(s) (Maximum 3 ears) r NA
s
Clean effluent filter At least once eve : 1.5 a year(s) r NA
month(s)
Inspect pump, pump controls & alarm At least once eve : r year(s) r NA
r M 77M.
Flush laterals and pressure test At least once eve : r- year(s) r NA
month(s)
Other: At least once eve : r year(s) r NA
Other:
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master
Plumber; Master Plumber Restricted Sewer; POWTS Insepector; POWTS Maintainer; Septage Servicing Operator (pumper). Tank
inspections must include a visual inspeciton of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on ground surface. The
dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent
on the ground surface. The ponding of effluent on the ground surface may indicated a failing condition and requires the immediate
notification of the local regulatory authority.
When the combined accumualtion of sludge and scum in any treatment tank equals one-third or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin
Admininistrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, petreatment units,
and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 30 days of completion of any service event.
(Rev.2/05)
Page 6
Page of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other
chemicals or sediment that may impede the treatment process and/or damage the soil dispersal cell(s). If high concentrations are
detected have the contents of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During extended power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will
be discharged to the dispersal cell(s) in one large dose and may overload them resulting in the backup or surface discharge of effluent.
To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the
effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels
within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within
15 feet down slope of any mound or at-grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS:
antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain
(sump pump) discharge; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products;
pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely
abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks, pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil,
gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide the opportunity to obtain a sanitary permit for
a code compliant replacement system:
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 the time of their
permit issuance.
❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be
rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation
must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to
replace the failed POWTS.
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative
surface. Reconstructions of such systems must comply with the rules in effect at that time.
WARNING: TREATMENT TANKS AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES AND LACK SUFFICIENT
OXYGEN TO SUPPORT LIFE. NEVER ENTER A TREATMENT TANK OR HOLDING TANK UNDER ANY
CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK IS VERY DIFFICULT.
ADDITIONAL INFORMATION:
POWTS INSTALLER POWTS MAINTAINER
Name: John Schmitt Name: John Schmitt
Phone: 715-760-0486 Phone: 715-760-0486
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name: Owners Choice Name: St Croix County Zoning
Phone: Phone: 715-3864680
This document is intended to meet minimum requirements of Ch. Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
Use of this document does not guarantee the performance of the POWTS.
Page(r7ev. 2/05)
Installation Instructions for
FEZ ow
EZ~ow Systems in Wisconsin by1N 7Y
FILTRwTOR
.
Wisconsin Department of Commerce, Safety and Buildings 5. The Absorption area (SF) necessary for a given site shall
Division, has reviewed the specifications and/or plans for this be sized based on maximum daily sewage flow (GPD) and
product and determined it to be in compliance with chapters the Permeability for the site. If certain criteria is met, the
Comm 82 through 84, Wisconsin Admin. Code, and Chapters EISA sizing can be used in Wisconsin, resulting in a 40%
145 and 160, Wisconsin Statutes. All sites must meet the Site smaller drainfield.
& Soil Conditions & Locations & Isolation distances as noted in
local regulations. 6. Place EZflow bundle(s) in the EZflow configuration ap-
proved by system design permit specified for the particu-
The approved products are 1203H (3-12" bundles with pipe in lar site. The top or center-most bundles containing pipe
center bundle in 5' or 10' lengths) and 1203HP (3-12" bundles are joined end to end with an internal pipe coupler. Any
with pipe in each bundle in 5' or 10' lengths. additional aggregate only bundles that may be required,
should be butted against the other aggregate-only bun-
A single pipe bundle contains a four inch perforated pipe sur- dles and do not require any type of connection.
rounded by EPS aggregate and is held together with poly-
ehtylene netting. A single aggregate bundle contains aggregate 7. The top of each GEO cylinder contains a filter fabric pre-
only and is held together with polyethylene netting. manufactured in between the netting and aggregate. The
fabric is inserted to prevent soil intrusion. The installer
Materials and Equipment Needed shall make sure the the GEO is positioned upward and is
• EZflow Bundles in contact with the fabric contained in the adjacent cylin-
• EZflow Geotextile Fabric der before backfilling.
• EZflow Internal Pipe Couplers
• Pipe for Header and Inlet 8. The EZflow Drainfield Systems should be installed in a
• Backhoe/Excavator level trench in all directions (both across and along the
trench bottom) and should follow the contour of the ground
Installation Instructions surface elevation (uniform depth), with all continuous
The instructions for installation of EZflow products are given adjoining 10-foot cylindrical bundles placed end to end,
below. This product must be installed in accordance with state with central bundle distribution pipe interconnected,
rules defined in chapters Comm 82 through 84, Wisconsin Ad- without any dams, stepdowns or other water stops.
ministrative Code, and Chapters 145 and 160, Wisconsin Stat-
utes, as well as the local health department's current design 9. The trench top shall be graded such that water will not
manual. pond. Backfill should be seeded or sodded immediately
after completion to reduce erosion.
1. After the local health department has determined sizing, ;
configuration, and layout for the EZflow systems, stake 10. EZflow EPS bundles are flexible and can fit in curved
or mark with paint the location of trenches and lines. Be trenches as may be necessary to avoid trees, boulders, or
careful to set correct tank, invert pipe, header line or dis- other obstacles.
tribution box and trench bottom elevations before instal-
lation of pipe bundles. 11. EPS aggregate is lighter than water, therefore, it might
be expected that natural buoyancy forces would tend to
2. Remove plastic EZflow shipping bags prior to placing cause EZflow assemblies to float out of ground when
bundles in the trench(es). Remove any plastic bags in the ponding occurs. Field experience has shown, however,
trench before system is covered. that this is not a problem when systems have a minimum
of 6" of soil cover as recommended by manufacturer.
3. This product must have geotextile fabric that meets re-
quirements of s. Comm 84.30 (6) (g), Wis. Adm. Code,
installed directly on top of the product and extending 1203H-GEO
down along the sides of the product to a point at least six
inches from the bottom of product. Geotextile
• ; o Barrier Material
4. When installed in a trench, the trench should be dug to
a width of 36 inches. This not only saves labor in excava- : 12"
lion, but also provides better load-bearing capacity after '
backfilling is complete.
as'
Page 9
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer m 41i~
Mailing Address 2~o T H I R
Property Address 3 If- Z / Jc- t/ ~ '
(Verification required from Planning & Zoning Department for new construction.)
City/State Parcel Identification Number 0- Z -Z/77- O 3 -ODD
F,5 .,~1` r W
LEGAL DESCRIPTION
Property Location 25 '/4 , Sec. T D N R/,5' W, Town of <<j'~ ~9 ~:S E
Subdivision Plat: ST nepl x- NAT/d/U 4 L 5gy7 feoe/U Z-57-4 T'c_s, Lot # 3
Certified Survey Map Volume , Page #
Warranty Deed # (before 2007)Volume , Page #
Spec house ! yes Vho Lot lines identifiable7yes o
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. 1/we am/are the owner(s) of the
property described above, by virtue of a wa my deed recorded in Register of Deeds Office.
P~
Number of bedrooms
L~7 SIGNA RE 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. 09/07)
Aug.23.2012 12:20 PM NANCY HUBERTY 6514261740 PAGE. 2/ 2
S-r. CROIX ' - JN•rV
SEPTIC TANK MAINTENANCE ACIREEIv ENT
AND
OWNISRSI°Ilf' CERTIFICATION F0kM
Owner/Buyer y - _ I
Mailing Address
Property Address
(Verification requitod from Planning A Zoning nYht for new construction.)
City/State Parcel Identifictition Number Fu 2--Z)'7z -03-0
3AEtiAL D&§.Q P'I'1t1N
Property Location . Y,,
K, Sec. _/A, T,3O...N R. 9 W. Torun of,J pm c=eSCT ,
Subdivision Plat:_ ST, C,i;'O/ x ?NJ6 L ,S pU THC,t_✓11-1 Lot # ~
Certlf'led Survey Map # _ . voiulno . page #
Warranty Deed # (before 2007)V«lume _ Page #
Spec house ; ; yes>ti no Lot lines identifiable j- t yes,", no
SYSTEM MAIMTENAM,-F AND OWNER CLMnEICATION
Improper use and maintenance of your septic system could result in its premature failuro h> handle wastes. Proper
nulntunaneei consists of pumping out tlw septic lank every three years or suunor, if ucadod, by is licensed pumpor. W but you put. into
the system can affect the function of the septic tank as a treatment stages in tlw waste disposal system. Owner maintenance
rosponsibil Was are specified In §C:omm, 83,52(1) and in Chapter 12 - St. Croix County Sanitary, Ordinance.
The property Owner agrees to subinit to St. Croix C'oanty Planning & Zonins Department a certification form, signed by the
owner and by at rmtstc r plumber, journcyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site
w63tpwatesr disposal system is In proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank ii
less than 1/3 toll ufAudgn,
I/we, the undersigned have read the above requirements turd agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department or Commerce and thu Department of Natural Resources, State of Wiavonsin.
Certification stating that your septic system has been maintained must be completed and returned to County
tlt St Croi
Zoning o x Planning &
Department wi
thin 30 days of the three year expiration date.
I/we certify that all statements on this form are true to the best of my/ulir knowledge. Uwe atiVare the owner(s) of the
pmporty de-scritmd above, by virtue of a warranty dead recorded in Register of Deeds Office.
( Number of bedruonis
St~~ 'rURi c~l~ ~t`,l~riivi•(~) i.. ~ ~ vri'i~~
"Any information that is mismproscnted may result in the sanila y permit being revoked by the tlanning Zeroing Department.
Include with this application a recorded warranty deed from the Register of Oeeds Office and a copy of the certified survey map if
reference is inada in the warranty decd.
(REV. 09/07)
: ` 1II 11 li ! it I Ill liilllll lillllllllill
ills 111111 l i Il i i
* 9 1 0 1 4 1 3
910141
State Bar of Wisconsin Form 3-2003 BETH PABST
QUIT CLAIM DEED REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
Document Number Document Name 01/13/2010 10 : 05AM
QUIT CLAIM DEED
THIS DEED, made between Residential Development, inc., a Minnesota EXEMPT 1 14
corporation REC FEE: 15.00
("Gran r," whether one oT more), PAGES : 3
and Signature Bank a Minnesota banking corporation
("Grantee," whether one or more).
Grantor quit claims to Grantee the following described real estate, together with the Recording Area
rents, profits, fixtures and other appurtenant interests, in St. Croix j
County, State of Wisconsin ("Property") (if more space is needed, please attach Name and Return Address
addendum): signature Bank
Attn: Daniel Koch
9800 Bren Road East, Suite 200
SEEADDENDUM Minnetonka. MN 55343
See Attached Exhibit A
S Paroet Identification Number (PM)
This is not homestead propcay.
(is) (is not)
Dated a ' ' v~G 9
(SEAL) (SEAL)
. ResidentKizo vei nt, Inc.
(SEAL} (SEAL)
* Rick D. Murray, its President
AUTHENTICATION ACKNOWLEDGMENT
Signature(s)
STATE OF t1f4Grz-. +lV1 t,y n1E5 . h )
authenticated on ) ss.
n)4 I. 1 COUNTY )
* Personally carne before me one
TITLE: MEMBER STATE BAR OF WISCONSIN the above-named Rick D. Murray, President Residential
Development, Inc. a Minnesota corporation
al tharized by Wis. Stat. § 706.46) to me n to be the pe on s) who ex used a foregoing
lost en and ackno the same.
I
THIS INSTRUMENT DRAFTED BY:
yy A ` * t e: -n ? 1
~ASlovt ~d.taw.w... I~er/µ~..n d~ f3rra.Q-_ L`P Lam) ~ _ - ~
- y
Notary ublic, State of VOis2bnsin
M&Alok q o 5 . Sw FS414-9 CLt~~ b7r3-8 My Commission (is permanent) (expires:
Iw.J SS*a' i .
M : ~~+•wPo~i (Signatures may be authenticated or acknowledged. Both are not necessary.) i
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
QuiT CLAIM DEED Q 2003 STATE BAR OF WISCONSIN FORM NO. 3-2003
Type name below signatures. #636054vI
1 of 3
ADDENDUM TO QUIT CLAIM DEED
t
Parcel 1
Lots 2, 4, 7, 11, 12, 13, and 14; St. Croix National Southern Estates; Town of Somerset,
St. Croix County, Wisconsin
Parcel 1 is hereafter referred to as the Subject Property.
The Subject Property is subject to that certain Combination Purchase Money and Construction
Mortgage, Security Agreement and Fixture Financing Statement dated June 21, 2404, filed with
the St. Croix County Recorder as Document No. 766746 and part of the Subject Property is
subject to that certain Mortgage dated November 8, 2007, fled with the St. Croix County
Recorder as Document No. 864492 (collectively the "Mortgage'.
Grantor and Grantee acknowledge that it is their joint intent that the lien of the Mortgage shall
not . be merged with the fee simple interest of the Subject Property herein being acquired by
Grantee, it being understood that the debt secured by the Mortgage is still outstanding and that
the Mortgage will continue to secure such debt notwithstanding the conveyance of the Subject
Property as evidenced by this deed.
'This deed is intended to be, and is, an absolute conveyance of the title to the Subject Property to
Grantee, and is not intended as a mortgage, trust conveyance, or security of any kind; that it is
the intent of the Grantor'to convey, and by this deed convey to Grantee all of Grantor's right,
title and interest absolutely, in and to the Subject Property, including the right to reinstate,
contest foreclosure, bid at the sheriff's sale and redeem from the foreclosure of the Mortgage,
and that possession of the Subject Property has been surrendered to Grantee simultaneously with
the delivery of this deed.
I
i
• 1
u63600Y)
i
2 of 3
Exhibit A
Parcel Identification Numbers:
032-2172-02-000
032-2172-03-000
032-2172-04-000
032-2172-07-000
032-2172-11-000
032-2172-12-000
032-2172-13-000
032-2172-14-000
3of3
UJ 8
- - - S 89*21 YOV' 5092.22` S 89'2
r- I'M
C-4 rn Q ,.-Center of Section t8
S21.
186.79
232.2
114.69 72.1 tl: 19+ O
•-266:10'---,;~....-
130,701 sq. f t: $
acres u
rn 3.000
0 2 386 sq.ft.. c
M 3.498 acres,
130,877 sq.ft..
3.004 acres m r
fr
p ~ EDP
!off
w
.r
w
111
\
4 ,ter .w•~^' rte. P
s r
10 SWICIZ
1
r,.. AN
to t: I
Qj 33 -1 69
in 1.
Lo'
in a
v C14 k0
zia ita f a~ 19 .
cz~ ! Co ~ ~
' x
v 1450
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Steel's Soil Service Inc.
Attach complete sfte plan on paper not less than 8'% x 11 inches in size. Plan must County St. Croix
include but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. O~-7d- 3
Please print a# ' I Vt R iew Date
xa
Personal information you provide may be used for second L:1Ka6jU6, s. 15 046(1) (m)).
Property Owner Property Location
Residential Development, Inc. Govt Lot na NW 1/4 SE 1/4 S 18 T 30 NR 19 W
Property Owner's Mailing Address i Lot Block # Subd. Name or CSM#
8929 Aztec Dr. 3 na St. Croix National Southern Estates
City State Zip CbdaA~rerrelVamtrer- v. _ J City _j Village 0 Town Nearest Road~,4
Eden Prairie MN 55347 952-934-6238 Somerset 3 2
A6 New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
J Replacement J Public or commercial - Describe:
Parent material Knolls of pitted outwash Flood plain elevation, if applicable na
General comments
and recommendations: Conventional system, system elevation 90.73ft.Trenches spaced and depth to code 6.17ft below grade.
c4r+. ft S44-14 '74 4.7 rxCz-
Boring # Boring
.I Pit Ground Surface elev. 96.20 ft. Depth to limiting factor 120 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft=
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-8 10yr3/2 none sit 2msbk mfr gw Tna.4 .8
2 8-20 10yr4/4 none sicl 2msbk mfr gw .6
3 20-32 7.5yr4/4 none sl 2msbk mfr gw 1.0
4 32-52 7.5yr4/4 none sl/cos 2msbk mfr gw na .6 1.0
5 52-120 7.5yr4/6 none co osg ml na na .7 1.6
Fil wi Boring # Boring
Pit Ground Surface elev. 96.20 ft. Depth to limiting factor 120 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-4 10yr3/1 none sil 2msbk mfr cs 1f .6 .8
2 4-11 10yr4/4 none sl 2msbk mfr gw na .6 1.0
3 11-32 7.5yr4/4 none sl 2msbk mfr gw na .6 1.0
4 32-60 7.5yr4/6 none Ifs 2msbk mfr gw na .5 1.0
5 60-120 7.5yr4/6 none cos osg ml na na .7 1.6
1
* Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 150 mg. * Effluent #2 = BOD5 130 mg/L and TSS <30 mg/L
CST Name (Please Print) ignature: CST Number
David J. Steel 248956
Address Steel's Soil SerVj ce In Date Evaluation Conducted Telephone Number
C1,4`{ ~0,7 5 776a / WI 5406 z 7/14/2004 715- 6 J~ ed
Property Owner Residential Development, Inc. Parcel ID # Pending Page 2 of 3
F 3]Boring # Boring
f Pit Ground Surface elev. 92.30 ft. Depth to limiting factor 120 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-12 10yr3/2 none sil 2msbk mfr CS 1vf .6 .8
2 12-36 10yr4/4 none sicl 2msbk mfr gw 1vf .4 .6
3 36-51 10yr4/4 none sicl 2msbk mfr gw na .4 .6
4 51-66 7.5yr4/4 none sl 2msbk mfr gw na .6 1.0
-
5 66-120 7.5yr4/6 none cos/ms osg ml na na .7 1.6
F-1 Boring # I Boring
_j Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtft!
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
F-1 Boring # I Boring
~ Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 <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.
Page 3 of 3
STEEL'S SOIL SERVICE INC.
David J. Steel 994 200` St.
CST-POWTSM Residential Development, Inc. Baldwin, WI 54002
Lic. #248956 NWl/4,SEl/4,S18,T30N,RlgW Bus.(715) 684-5680
Town of Somerset, St. Croix Co. Fax.(715) 684-3449
St. Croix National Southern Estates, Lot 3
This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your
use. The location of this test may or may not be as shown, as permanent lot lines were not established at
the time the soil test was conducted. Legend
1" = 40'
♦ =Benchmark Ele. 100.00Ft
Top of 3/4" pvc pipe
• = Alt Benchmark Ele. 99.80Ft
Top of 3/4" pvc pipe
11 = Borings
Boring Elevations
B 1 = 96.90Ft
B2 = 96.90Ft
B3 = 92.30Ft
B4 = 00.0017t A1410 , f3
31
A, T-1 A113
9i
ll~~ 03
51~
3?'
br
A. X33'
g~.2oG~
rtivm~nvm mv~~vmu•
SINGLE FAMMY RESIDENCE N
SINGLE FAMMY RESIDENCE
I FOUND CENTER
SECTION 18 \ ~r
~ ~ # r , } ~ • , RBI PII~ ~
8b
f t
r ~ ~ fit.. ~ ' o I
v / rn i.
\ 3.W r'
/ A , ,
s ~
-74.21
2 3 ,
+ + / / ~ 9 • g i S62
I p0 / 12 U 11i r ~ ~i
/ g5• ca 1 ,